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Individual

BRADLEY LODGE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
3192 GLEN CANYON RD, SCOTTS VALLEY, CA 95066-4916
(831) 438-1868
(831) 438-2789
Mailing address
3600 GLEN CANYON RD, SCOTTS VALLEY, CA 95066-4923
(831) 438-1868
(831) 438-2789

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
A060541021
CA

Other

Enumeration date
02/06/2026
Last updated
02/06/2026
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