Provider Demographics
NPI:1043229321
Name:BRADFORD, PATRICIA KAY (MED, LPC, MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:KAY
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:MED, LPC, MT-BC
Other - Prefix:MRS
Other - First Name:TRICIA
Other - Middle Name:KAY
Other - Last Name:BRADFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED, LPC, MT-BC
Mailing Address - Street 1:6910 W 45TH AVE
Mailing Address - Street 2:SUITE 23
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-5078
Mailing Address - Country:US
Mailing Address - Phone:806-355-7755
Mailing Address - Fax:806-355-6842
Practice Address - Street 1:6910 W 45TH AVE
Practice Address - Street 2:SUITE 23
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-5078
Practice Address - Country:US
Practice Address - Phone:806-355-7755
Practice Address - Fax:806-355-6842
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14142101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health