Walter Matthew Bradley, CDP

Primary specialty

CounselorTaxonomy code 101Y00000X

License

RC00042626 Issued in WA

Practice address

1800 112TH Ave NE
Suite 150W
Bellevue, WA 98004-2993

Phone

(425) 646-7279

Fax

(425) 646-7499

NPI assigned

May 14, 2009

Sex

Male

Sole proprietor

No

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1242259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1242259200000",
    "number": "1336373653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 112TH AVE NE",
            "address_2": "SUITE 150W",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980042993",
            "telephone_number": "425-646-7279",
            "fax_number": "425-646-7499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 112TH AVE NE",
            "address_2": "SUITE 150W",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980042993",
            "telephone_number": "425-646-7279",
            "fax_number": "425-646-7499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "WALTER",
        "middle_name": "MATTHEW",
        "name_prefix": "Mr.",
        "credential": "CDP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-14",
        "last_updated": "2009-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WA",
            "license": "RC00042626",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP60048753",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara Leann Boyd, N.D.
• Jason J Boyer, MD
• Lisa Megumi Boyle, L.AC., DIPL. O.M.
• Connie Red Braat, LMP
• Henry Lee Bradbury III, PA-C, MPAS
• Laura Brady
• Jossalyn Braile
• Brandon Brake, BCBA, LBA
• Jackson Brammer
• Clara Brand, LICSW, LCSW

• Counselor in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2009; 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.