Individual
KELLIE BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
700 CHILDRENS DR, COLUMBUS, OH 43205-2664
(614) 722-5793
(614) 722-9069
Mailing address
DEPT 781625, PO BOX 78000, DETROIT, MI 48278-1625
(614) 355-8004
(614) 355-2220
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
C.1600699
OH
101YP2500X
Professional Counselor
Primary
E.2001879
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1473276
—
OH
Enumeration date
02/15/2017
Last updated
03/22/2021
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