Provider Demographics
NPI:1306450598
Name:TRATHEN, BRADLEY JAMES (MA, LPCC)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JAMES
Last Name:TRATHEN
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18325 COUNTY ROAD 366 # 2036
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81211-8900
Mailing Address - Country:US
Mailing Address - Phone:517-449-8257
Mailing Address - Fax:
Practice Address - Street 1:18325 COUNTY ROAD 366
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211-8900
Practice Address - Country:US
Practice Address - Phone:517-449-8257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0017496101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health