Provider Demographics
NPI:1982064002
Name:HOLLEY, BRADLEY (LLPC)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:HOLLEY
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:863 N PINE RD STE A
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-2159
Mailing Address - Country:US
Mailing Address - Phone:989-928-3566
Mailing Address - Fax:989-391-9596
Practice Address - Street 1:1480 N M 52 STE 1
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1025
Practice Address - Country:US
Practice Address - Phone:989-723-8239
Practice Address - Fax:989-391-9596
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015306101YM0800X
MI6401017764101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health