Provider Demographics
NPI:1083329940
Name:BRADLEY, ANA ALYCIA (LMFT-INTERN)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:ALYCIA
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LMFT-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9040 BOSTON SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-0409
Mailing Address - Country:US
Mailing Address - Phone:361-244-2136
Mailing Address - Fax:
Practice Address - Street 1:4455 S PECOS RD STE C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5029
Practice Address - Country:US
Practice Address - Phone:702-505-1280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI4088101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty