Provider Demographics
NPI:1932995891
Name:BRADFORD, TAMERA (CG 61683260)
Entity type:Individual
Prefix:
First Name:TAMERA
Middle Name:
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:CG 61683260
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14819 E MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1960
Mailing Address - Country:US
Mailing Address - Phone:509-315-9791
Mailing Address - Fax:
Practice Address - Street 1:14819 E MISSION AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1960
Practice Address - Country:US
Practice Address - Phone:509-315-9791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61683260101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor