Bradley Kebodeaux, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

1633 Issued in MS

Practice address

2100 E Chambers Dr
Booneville, MS 38829-8938

Phone

(662) 728-3174

Fax

(662) 728-3175

NPI assigned

Apr 22, 2010

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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

• Region IV Chemical Dependency Complex

  • Substance Abuse Rehabilitation Facility
  • Corinth, MS
  • NPI 1982980850
  NPD (past)
• Region IV Mental Health Services

  • Community/Behavioral Health Agency
  • Corinth, MS
  • NPI 1154601219
  NPD (past)
• Region IV Mental Health Services

  • Community/Behavioral Health Agency
  • Corinth, MS
  • NPI 1942579826
  NPD (past)

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

{
    "created_epoch": "1271894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472169600000",
    "number": "1447577002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 N MADISON ST",
            "city": "CORINTH",
            "state": "MS",
            "postal_code": "388345072",
            "telephone_number": "662-286-9883",
            "fax_number": "662-286-8095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 E CHAMBERS DR",
            "city": "BOONEVILLE",
            "state": "MS",
            "postal_code": "388298938",
            "telephone_number": "662-728-3174",
            "fax_number": "662-728-3175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEBODEAUX",
        "first_name": "BRADLEY",
        "name_prefix": "Mr.",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-04-22",
        "last_updated": "2016-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MS",
            "license": "1633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamiah Elizabeth Jones
• Rita D. Jones
• Jose L Madara Jr M D PA
• Maan Joudeh, MD
• Neiko Judon, M.ED, PCMHT
• Marilyn Rhoads Kelly, NP
• Ken Goodwin, DMD, PA
• Cherry Kennedy, L.P.N.
• Katie Kerr, FNP
• Heather J Kirk, FNP

• Professional Counselor in Booneville, MS
• Providers in Booneville, MS by specialty
• Professional Counselor in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2016; 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.