Provider Demographics
NPI:1841541661
Name:BRADLEY, NATHAN CHRIS (LMSW)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:CHRIS
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 ALMEDA RD
Mailing Address - Street 2:APT. 3302
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-4300
Mailing Address - Country:US
Mailing Address - Phone:806-236-5135
Mailing Address - Fax:
Practice Address - Street 1:3722 PINEMONT DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-1220
Practice Address - Country:US
Practice Address - Phone:713-426-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX564971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical