Provider Demographics
NPI:1992436943
Name:BRADLEY, CARMYNN KAYLEEN (CPC INTERN)
Entity type:Individual
Prefix:
First Name:CARMYNN
Middle Name:KAYLEEN
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:CPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 RENAISSANCE DR STE C
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6751
Mailing Address - Country:US
Mailing Address - Phone:702-845-0438
Mailing Address - Fax:
Practice Address - Street 1:2255 RENAISSANCE DR STE C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6751
Practice Address - Country:US
Practice Address - Phone:702-845-0438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI5100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health