Provider Demographics
NPI:1063938488
Name:BRADY, SCOTT PATRICK (LCPC, NCC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:PATRICK
Last Name:BRADY
Suffix:
Gender:M
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9311 S MILLARD AVE
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-1812
Mailing Address - Country:US
Mailing Address - Phone:708-439-6863
Mailing Address - Fax:
Practice Address - Street 1:9311 S MILLARD AVE
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-1812
Practice Address - Country:US
Practice Address - Phone:708-439-6863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health