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BENJAMIN BRADLEY LPC, LAC
Addiction (Substance Use Disorder) >> Counselor >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1801551148
Individual Registrant: BENJAMIN BRADLEY LPC, LAC
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
35 N ASH ST CORTEZ, CO 81321-3201 US
Tel: 970-565-4109 Fax: --
Tel: 970-565-4109 Fax: --
Contact information for business:
1548 BALSAM ST CORTEZ, CO 81321-2672 US
Tel: -- Fax: --
Tel: -- Fax: --
Registration Information:
NPI: 1801551148
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 101YA0400X | Behavioral Health & Social Service Providers Counselor Addiction (Substance Use Disorder) | CO | ACD.0001664 |
| Y | 101YM0800X | Behavioral Health & Social Service Providers Counselor | CO | LPC.0017238 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
