Provider Demographics
NPI:1043099286
Name:BRADLEY, CHLOE ANTOINETTE
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:ANTOINETTE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 E CAMBRIDGE AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-1024
Mailing Address - Country:US
Mailing Address - Phone:623-296-3179
Mailing Address - Fax:
Practice Address - Street 1:2445 E CAMBRIDGE AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-1024
Practice Address - Country:US
Practice Address - Phone:623-296-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility