Provider Demographics
NPI:1699927939
Name:BRADSHAW, JEAN MARIE (MFT, MS, MA, CHT)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:MARIE
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:MFT, MS, MA, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3553A ATLANTIC AVE # 569
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4515
Mailing Address - Country:US
Mailing Address - Phone:562-400-2135
Mailing Address - Fax:
Practice Address - Street 1:17215 STUDEBAKER RD
Practice Address - Street 2:SUITE #180
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2548
Practice Address - Country:US
Practice Address - Phone:562-400-2135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46310106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist