Doctor Name: | KEITH ALLEN BRADSHAW |
NPI Number: | 1457761652 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 18750 N 6750 E Mount Pleasant, UT - 846472309 |
Business Phone Number: | 8013754240 |
Business Fax Number: | 8013754241 |
Mailing Address: | 619 N 500 W, PROVO |
State: | UT |
Postal Code: | 846011547 |
Phone Number: | 8014200465 |
Fax Number: | |
NPI Enumeration Date: | 04/28/2014 |
NPI Last Update Date: | 04/28/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |