Provider Demographics
NPI:1134581887
Name:BRADLEY, ANDREW
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 WHEELER ST STE 108
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-4472
Mailing Address - Country:US
Mailing Address - Phone:515-996-6778
Mailing Address - Fax:515-450-5038
Practice Address - Street 1:809 WHEELER ST STE 108
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-4472
Practice Address - Country:US
Practice Address - Phone:515-996-6778
Practice Address - Fax:515-450-5038
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA091725101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health