Travis Matthew Bradey

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

A9603 Issued in NC

Practice address

209 Barium Springs Dr
Statesville, NC 28677-8454

Phone

(704) 873-1011

Fax

(701) 832-2253

NPI assigned

Jan 24, 2014

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1390521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390521600000",
    "number": "1316360415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1",
            "city": "BARIUM SPRINGS",
            "state": "NC",
            "postal_code": "280100001",
            "telephone_number": "704-832-1011",
            "fax_number": "704-832-2253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 BARIUM SPRINGS DR",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286778454",
            "telephone_number": "704-873-1011",
            "fax_number": "701-832-2253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADEY",
        "first_name": "TRAVIS",
        "middle_name": "MATTHEW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-01-24",
        "last_updated": "2014-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "A9603",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "A9603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC BOARD OF LPC - LMFTA",
            "identifier": "A9603",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Antoine Boulware, LCSW
• Shirley Anne Bowles, ED.D.
• Danita Bowling, J.D., PH.D.
• Janine Lynne Bowman, PHD
• Dianne Elliott Braddock, DA II
• James Hedrick Bradford, M.D.
• Tamiko Bradley
• Erin Elizabeth Brady, PHARMD
• Helen Denise Bragg
• Leesah Workman Bragg, RN

• Professional Counselor in Statesville, NC
• Providers in Statesville, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2014; 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.