Organization
EAST BAY PSYCHOLOGY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERENCE LEE BRADLEY PHD (OWNER & CEO)
(231) 938-5900
Entity
Organization
Contact information
Practice address
3926 VILLAGE CIRCLE DR., TRAVERSE CITY, MI 49686
(231) 938-5900
(231) 938-5900
Mailing address
3926 VILLAGE CIRCLE DR., TRAVERSE CITY, MI 49686
(231) 938-5900
(231) 938-5900
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301002718
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0B81230
BCBS-M
MI
01
—
0Z5488
BCBS-M
MI
Enumeration date
01/21/2015
Last updated
01/23/2015
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