Most Relevant Information
Provider Data
| NPI Number: | 1003695776 |
| Provider Name: | ELISA K BRADLEY |
| Entity Type: | Individual |
| Taxonomy Code: | 101YP2500X |
| Specialty: | Counselor |
| License Number: | C.2305414 |
Most Important Dates
| Enumeration Date: | 09/22/2023 |
| Last Updated: | 09/22/2023 |
Provider Practice Location
2963 BLUE JACKET CT
LIMA
OH
458061464
Practice Location Phone/Fax
| Phone: | 5678251192 |
| Fax: |
Provider Mailing Location
2030 W ELM ST
LIMA
OH
458052654
Provider Mailing Phone/Fax
| Phone: | 4192342134 |
| Fax: |