Provider Information for 1417601097
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Dr. MICHELLE BRADHAM-COUSAR PhD, CRC, LMHC, NCC
Sex: Female
NPI: 1417601097
Last Updated: 2022-02-11
Certification Date: 2022-01-29
Certification Date: 2022-01-29
Details
| Name | Value | ||||||||||||||||
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| NPI | 1417601097 | ||||||||||||||||
| Enumeration Date | 2022-02-11 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 10121 E ADAMO DR UNIT 89761 TAMPA, FL 33689-9038 United States Phone: | Fax: | ||||||||||||||||
| Primary Practice Address | 1503 S US 301 UNIT 92 TAMPA, FL 33619 United States Phone: 941-250-5446 | Fax: | ||||||||||||||||
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