Provider Demographics
NPI:1912257395
Name:BRADLEY, JENNIFER RENEE (LPC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:RENEE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:BAKER
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1401 DOUG BAKER BLVD
Mailing Address - Street 2:STE 107 PMB 524
Mailing Address - City:CHELSEA
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4975
Mailing Address - Country:US
Mailing Address - Phone:205-880-4742
Mailing Address - Fax:205-301-7356
Practice Address - Street 1:1401 DOUG BAKER BLVD
Practice Address - Street 2:STE 107 PMB 524
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-3975
Practice Address - Country:US
Practice Address - Phone:205-880-4742
Practice Address - Fax:205-301-7356
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2175101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor