Doctor Name: | MARTI K BRADLEY |
NPI Number: | 1184635146 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW ACSW LICSW |
License Number: | LW00006668 |
Business Practice Address: | 109 E 3rd Ave Ste 7 Ellensburg, WA - 989263357 |
Business Phone Number: | 5099252123 |
Business Fax Number: | 5099252008 |
Mailing Address: | 109 E 3rd Ave Ste 7, ELLENSBURG |
State: | WA |
Postal Code: | 989263357 |
Phone Number: | 5099252123 |
Fax Number: | 5099252008 |
NPI Enumeration Date: | 08/11/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LW00006668 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |