| Doctor Name: | MR. MICHAEL-DAVID ROBERT BRADFORD |
| NPI Number: | 1114010451 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | 20103 |
| Business Practice Address: | 3045 Trinity Lakes Dr Hurst, TX - 760537458 |
| Business Phone Number: | 8177268165 |
| Business Fax Number: | |
| Mailing Address: | 3045 Trinity Lakes Dr, HURST |
| State: | TX |
| Postal Code: | 760537458 |
| Phone Number: | 8177268165 |
| Fax Number: | |
| NPI Enumeration Date: | 09/30/2006 |
| NPI Last Update Date: | 08/31/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 20103 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |