| Doctor Name: | MR. ROLLA MERLE BRADLEY |
| NPI Number: | 1063765246 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC-S, NCC |
| License Number: | 14527 |
| Business Practice Address: | 19185 Fm 2252 Garden Ridge, TX - 782662574 |
| Business Phone Number: | 2108595446 |
| Business Fax Number: | 2102651555 |
| Mailing Address: | 9352 Osage Cir, GARDEN RIDGE |
| State: | TX |
| Postal Code: | 782662060 |
| Phone Number: | 2108595446 |
| Fax Number: | 2102651555 |
| NPI Enumeration Date: | 10/25/2012 |
| NPI Last Update Date: | 10/25/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP1600X |
| License Number: | 14527 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Pastoral |
| Taxonomy Definition: | |