Provider Demographics
NPI:1427544030
Name:SHOW, BRADLEY (LPC)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:SHOW
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 NW YORK DR STE 150
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-7265
Mailing Address - Country:US
Mailing Address - Phone:541-678-3268
Mailing Address - Fax:
Practice Address - Street 1:593 NW YORK DR STE 150
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-7265
Practice Address - Country:US
Practice Address - Phone:541-678-3268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC6292101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR136460OtherRIMROCK TRAILS TREATMENT SERVICES