Provider Demographics
NPI:1912257395
Name:BRADLEY, JENNIFER RENEE (LPC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:RENEE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:BAKER
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:16700 HIGHWAY 280 STE A222
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:AL
Mailing Address - Zip Code:35043-8325
Mailing Address - Country:US
Mailing Address - Phone:205-677-8134
Mailing Address - Fax:844-579-0080
Practice Address - Street 1:16700 HIGHWAY 280 STE A222
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:AL
Practice Address - Zip Code:35043-8325
Practice Address - Country:US
Practice Address - Phone:205-677-8134
Practice Address - Fax:844-579-0080
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2175101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor