Provider Demographics
NPI:1013181155
Name:BRADSHER, MAVIS ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:MAVIS
Middle Name:ANN
Last Name:BRADSHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9407 ROXANNA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-6103
Mailing Address - Country:US
Mailing Address - Phone:512-282-6330
Mailing Address - Fax:
Practice Address - Street 1:1715 FM 1626
Practice Address - Street 2:STE 105-2
Practice Address - City:MANCHACA
Practice Address - State:TX
Practice Address - Zip Code:78652-3553
Practice Address - Country:US
Practice Address - Phone:512-560-0998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-19
Last Update Date:2008-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX387671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical