Provider Demographics
NPI:1487108296
Name:DAILEY, BRADLEY MATTHEW (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:MATTHEW
Last Name:DAILEY
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 KELLER ST
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:IL
Mailing Address - Zip Code:60545-1486
Mailing Address - Country:US
Mailing Address - Phone:630-536-9558
Mailing Address - Fax:
Practice Address - Street 1:2535 BETHANY RD
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3126
Practice Address - Country:US
Practice Address - Phone:815-264-2154
Practice Address - Fax:815-264-2315
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178010566101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional