Provider Information for 1033323696
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Mr. PERRY BRAD BAGLEY MS, QP, LMFT
Sex: Male
NPI: 1033323696
Last Updated: 2019-06-11
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1033323696 | ||||||||
| Enumeration Date | 2007-05-10 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2313 EXECUTIVE CIR STE C GREENVILLE, NC 27834-3744 United States Phone: 252-215-5716 | Fax: | ||||||||
| Primary Practice Address | 2313 EXECUTIVE CIR STE C GREENVILLE, NC 27834-3744 United States Phone: 252-215-5716 | Fax: | ||||||||
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