Terence Lee Bradley, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

002718 Issued in MI

Practice address

3926 Village Circle Dr
Traverse City, MI 49686-6305

Phone

(231) 938-5900

NPI assigned

Jan 9, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• East Bay Psychology, PC

  • Clinical Psychologist
  • Traverse City, MI
  • NPI 1417346966
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487116800000",
    "number": "1033268149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12501 SW TORCH LAKE DR",
            "city": "RAPID CITY",
            "state": "MI",
            "postal_code": "496769333",
            "telephone_number": "231-883-3066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3926 VILLAGE CIRCLE DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496866305",
            "telephone_number": "231-938-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "TERENCE",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-09",
        "last_updated": "2017-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "002718",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "CP11369",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tabetha Bradburn, BEHAVIOR TECHNICIAN
• Kaylee Ann Bradeen, OTR/L
• Jenna Bradfield, LLMSW
• Jessica Jackline Bradley, PHARM.D.
• Tanner William Bradley
• Robert Bradshaw
• Ashley Rebecca Bradt, D.O.
• Barent Bradt, DO
• Erika Lynne Bradway, PT
• Madelynn Kaye Brady

• Clinical Psychologist in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.