Individual
JESSE M BRADBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPCC
Contact information
Practice address
3027 PRESTON HWY, LOUISVILLE, KY 40217-1716
(502) 653-7211
(502) 416-0723
Mailing address
130 FAIRFAX AVE STE LLC, LOUISVILLE, KY 40207-4939
(502) 653-7211
(502) 416-0723
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
247680
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100593740
—
KY
Enumeration date
05/07/2019
Last updated
05/11/2026
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