Provider Demographics
NPI:1043675432
Name:BRADSHAW, HAROLD
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:
Last Name:BRADSHAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5725 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4382
Mailing Address - Country:US
Mailing Address - Phone:307-265-4073
Mailing Address - Fax:307-265-2460
Practice Address - Street 1:5725 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4382
Practice Address - Country:US
Practice Address - Phone:307-265-4073
Practice Address - Fax:307-265-2460
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPMFT-278103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst