Provider Demographics
NPI:1215338918
Name:HANSON-BRADLEY, CARRIE LYN (LMFT)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYN
Last Name:HANSON-BRADLEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:LYN
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:3070 STRATFORD AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-4246
Mailing Address - Country:US
Mailing Address - Phone:801-631-7866
Mailing Address - Fax:
Practice Address - Street 1:4535 NORMAL BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5576
Practice Address - Country:US
Practice Address - Phone:402-413-9994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1998106H00000X
NE1459106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist