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Individual
MR. BRADLEY PAUL ROAN EAGLE
Active
Individual
MR. BRADLEY PAUL ROAN EAGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CADC-RT-20-486
OR
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-20-486
OR
171M00000X
Case Manager/Care Coordinator
20-QMHA-R-0842
OR
175T00000X
Peer Specialist
21-CRM-411
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21-CRM-411
CRM CERTIFICATE - MHACBO
OR
05
—
50079031
—
OR
Enumeration date
12/20/2019
Last updated
11/17/2025
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