Provider Information for 1801551148
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BENJAMIN BRADLEY LPC, LAC
Sex: Male
NPI: 1801551148
Last Updated: 2021-11-02
Certification Date: 2021-11-02
Certification Date: 2021-11-02
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1801551148 | ||||||||||||
| Enumeration Date | 2021-11-02 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 1548 BALSAM ST CORTEZ, CO 81321-2672 United States Phone: | Fax: | ||||||||||||
| Primary Practice Address | 35 N ASH ST CORTEZ, CO 81321-3201 United States Phone: 970-565-4109 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 1548 BALSAM ST | ||||||||||||
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