Provider Demographics
NPI:1316421639
Name:BRADSHAW, DAVID (MS, LMHC, NCC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BRADSHAW
Suffix:
Gender:M
Credentials:MS, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 STARFISH LN
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-9638
Mailing Address - Country:US
Mailing Address - Phone:360-559-1473
Mailing Address - Fax:323-817-3202
Practice Address - Street 1:4850 STARFISH LN
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230-9638
Practice Address - Country:US
Practice Address - Phone:360-559-1473
Practice Address - Fax:323-817-3202
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health