Individual
BRADLEY STALKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LPC
Contact information
Practice address
1348 BALDWIN ST, JENISON, MI 49428-8937
(616) 404-4564
Mailing address
1348 BALDWIN ST, JENISON, MI 49428-8937
(616) 404-4564
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6401018452
MI
101YP2500X
Professional Counselor
Primary
6401224881
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1134715303
NPI
MI
01
—
1437651916
NPI
MI
Enumeration date
12/11/2020
Last updated
03/25/2026
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