Active NPI
Elisa K Bradley
- Professional Counselor
- Lima, OH
National Provider Identifier
1003695776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- C.2305414
- Practice address
- 2963 Blue Jacket CT
Lima, OH 45806-1464 - Phone
- (567) 825-1192
- NPI assigned
- Sep 22, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | C.2305414 | OH | Primary |
Addresses
Primary practice location
2963 Blue Jacket CT
Lima, OH 45806-1464
Mailing address
2030 W Elm St
Lima, OH 45805-2654
Phone (419) 234-2134
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C.2305414 | OH | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1695340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695340800000",
"number": "1003695776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2030 W ELM ST",
"city": "LIMA",
"state": "OH",
"postal_code": "458052654",
"telephone_number": "419-234-2134"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2963 BLUE JACKET CT",
"city": "LIMA",
"state": "OH",
"postal_code": "458061464",
"telephone_number": "567-825-1192"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADLEY",
"first_name": "ELISA",
"middle_name": "K",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-09-22",
"last_updated": "2023-09-22",
"certification_date": "2023-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "OH",
"license": "C.2305414",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lima, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.