Provider Demographics
NPI:1629636857
Name:JUMP, BRADLEY DANIEL (LPC)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:DANIEL
Last Name:JUMP
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:16403-1140
Mailing Address - Country:US
Mailing Address - Phone:814-573-0993
Mailing Address - Fax:
Practice Address - Street 1:222 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:16403-1140
Practice Address - Country:US
Practice Address - Phone:814-573-0993
Practice Address - Fax:833-422-0143
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011409101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional