Organization
NEW LIFE 360 INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHERRY BRADLEY LCSW, MCAP (CEO)
(734) 658-5055
Entity
Organization
Contact information
Practice address
1047 E BRANDON BLVD, BRANDON, FL 33511-5515
(813) 548-1166
Mailing address
1047 E BRANDON BLVD, BRANDON, FL 33511-5515
(813) 548-1166
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QV0200X
VA Clinic/Center
—
—
Other
Enumeration date
08/15/2018
Last updated
10/30/2019
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