Tabatha Bradley, LAC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

P2608004 Issued in AR

Practice address

204 Mississippi St S
Wynne, AR 72396-3025

Phone

(870) 208-8499

NPI assigned

Jun 21, 2024

Last updated

Aug 7, 2026By the provider in NPPES

Sex

Female

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Changes Behavioral Health, LLC

  • Community/Behavioral Health Agency
  • Wynne, AR
  • NPI 1114260486
  NPD

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

{
    "created_epoch": "1718928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786060800000",
    "number": "1184468472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 MISSISSIPPI ST S",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723963025",
            "telephone_number": "870-208-8499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 MISSISSIPPI ST S",
            "city": "WYNNE",
            "state": "AR",
            "postal_code": "723963025",
            "telephone_number": "870-208-8499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "TABATHA",
        "credential": "LAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-21",
        "last_updated": "2026-08-07",
        "certification_date": "2026-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "AR",
            "license": "A2406004",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AR",
            "license": "P2608004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Eugene Boeckmann, P.D.
• Katelyn Boles, LPC
• Leah M Boone
• Jessie Bouland, RN
• Asia Corrine Boykin
• Elizabeth Pleasants Bradshaw, M.D.
• Mark Standridge Bradshaw, M.D.
• Paige Alison Branham
• Brawner Counseling, LLC
• Elizabeth A Brawner, APRN

• Professional Counselor in Wynne, AR
• Providers in Wynne, AR by specialty
• Professional Counselor in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.