Provider Demographics
NPI:1891684858
Name:BRADLEY, MICHELE LEA (QMHP-C, CADC-R, CRMI)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:LEA
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:QMHP-C, CADC-R, CRMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16040
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-0040
Mailing Address - Country:US
Mailing Address - Phone:503-535-1168
Mailing Address - Fax:
Practice Address - Street 1:10230 SE CHERRY BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2821
Practice Address - Country:US
Practice Address - Phone:503-535-1151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
T-25-4880101YA0400X
OR23-CRM-1889175T00000X
OR24-QMHPC-001579101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist