Provider Demographics
NPI:1063794139
Name:BRADLEY, WENDY DENISE (LPC)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:DENISE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 BENTON AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-2303
Mailing Address - Country:US
Mailing Address - Phone:615-292-9770
Mailing Address - Fax:
Practice Address - Street 1:601 BENTON AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-2303
Practice Address - Country:US
Practice Address - Phone:615-292-9770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3353101YP2500X
GALPC006385101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty