Provider Demographics
NPI:1831638022
Name:BRADY, MICHELLE (CADC II A042521016)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BRADY
Suffix:
Gender:F
Credentials:CADC II A042521016
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50249 CESAR CHAVEZ ST STE K
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-1530
Mailing Address - Country:US
Mailing Address - Phone:760-393-0555
Mailing Address - Fax:760-393-0522
Practice Address - Street 1:50249 CESAR CHAVEZ ST STE K
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-1530
Practice Address - Country:US
Practice Address - Phone:760-393-0555
Practice Address - Fax:760-393-0522
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA042521016101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)