Individual
BENJAMIN BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC, LAC
Contact information
Practice address
35 N ASH ST, CORTEZ, CO 81321-3201
(970) 565-4109
Mailing address
1548 BALSAM ST, CORTEZ, CO 81321-2672
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
ACD.0001664
CO
101YM0800X
Mental Health Counselor
Primary
LPC.0017238
CO
Other
Enumeration date
11/02/2021
Last updated
11/02/2021
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