| Bradley Counseling Centers Licensed Clinical Social Worker Corporation | |
|
2519 W Shaw Ave Suite #100 Fresno CA 93711-3311 | |
| (559) 230-1008 | |
| (559) 230-1799 |
| Full Name | Bradley Counseling Centers Licensed Clinical Social Worker Corporation |
|---|---|
| Speciality | Social Worker |
| Location | 2519 W Shaw Ave, Fresno, California |
| Authorized Official Name and Position | Sallie Mae Bradley (PRESIDENT) |
| Authorized Official Contact | 5599167585 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bradley Counseling Centers Licensed Clinical Social Worker Corporation Po Box 27065 Fresno CA 93729-7065 Ph: (559) 916-7585 | Bradley Counseling Centers Licensed Clinical Social Worker Corporation 2519 W Shaw Ave Suite #100 Fresno CA 93711-3311 Ph: (559) 230-1008 |
| NPI Number | 1275979932 |
|---|---|
| Provider Enumeration Date | 05/21/2013 |
| Last Update Date | 03/28/2014 |
| Medicare PECOS PAC ID | 9739310103 |
|---|---|
| Medicare Enrollment ID | O20140327001783 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275979932 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | LW11249 (California) | Primary |
| Provider Name | Sallie M Bradley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215195029 PECOS PAC ID: 2769456896 Enrollment ID: I20040824000510 |
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