Kyra Kamille Bradley, MA, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

6401019513 Issued in MI

Practice address

3176 Blue Jaye LN
Twinsburg, OH 44087-3347

Phone

(234) 738-1421

NPI assigned

Sep 19, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kyra Kamille Bradley Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1348012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665705600000",
    "number": "1154671972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8984 DARROW RD STE 2-167",
            "city": "TWINSBURG",
            "state": "OH",
            "postal_code": "440872186",
            "telephone_number": "330-265-3194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3176 BLUE JAYE LN",
            "city": "TWINSBURG",
            "state": "OH",
            "postal_code": "440873347",
            "telephone_number": "234-738-1421"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "25507 Ecorse Rd",
            "address_purpose": "LOCATION",
            "city": "Taylor",
            "state": "MI",
            "postal_code": "481801555",
            "country_code": "US",
            "telephone_number": "313-292-7640",
            "fax_number": "313-292-9270",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "KYRA",
        "middle_name": "KAMILLE",
        "credential": "MA, LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-19",
        "last_updated": "2022-10-14",
        "certification_date": "2022-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401019513",
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401011094",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KYRA",
            "last_name": "BRADLEY",
            "middle_name": "KAMILLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Professional Counselor in Twinsburg, OH
• Providers in Twinsburg, OH by specialty
• Professional Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2022; 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.