Destiny D Bradley, M.ED., LPC, NCC
Individual provider Active NPI Mental Health Counselor · Leland, MS
NPI 1437802147 · NPPES record last updated Apr 10, 2024
Key facts
- NPI
- 1437802147
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 3065 (MS)
- Practice address
- 201 Baker Blvd
Leland, MS 38756-3401 - Phone
- (662) 686-4121
- Fax
- (662) 686-4770
- NPI assigned
- Feb 2, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Mental Health Counselor
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Indianola Clinic LLC
Practice addresses (Care Compare)
201 Baker Blvd
Leland, MS 38756-3401
Phone (662) 686-4121
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250212003101 | MS | Practitioner - Mental Health Counselor | 8820533300 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Education
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Indianola Clinic, LLC | Current |
Accepting new patients |
Locations
201 Baker Blvd
Leland, MS 38756
Phone (662) 686-4121
Interoperability endpoints
- destiny.bradley@dha.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 3065 | MS | Yes |
Addresses
Primary practice location
201 Baker Blvd
Leland, MS 38756-3401
Mailing address
219 N First Ave
Cleveland, MS 38732-2521
Phone (662) 641-2948
Other providers in Leland, MS
- Lauren Austin
- Ruth C Baker-Forbes
- Bell Therapy, LLC
- Elizabeth Bell
- Lacie A Brackeen
- Sheena Brown
- Nash Burnside
- Cassada Psychiatric Clinic PC
- Michelle B Clem
- Latoyia Cole
All providers in Leland, MS · Mental Health Counselor in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 10, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.