Provider Demographics
NPI:1184635146
Name:BRADLEY, MARTI K (MSW ACSW LICSW)
Entity Type:Individual
Prefix:
First Name:MARTI
Middle Name:K
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MSW ACSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W MAIN ST STE 207
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2872
Mailing Address - Country:US
Mailing Address - Phone:509-876-0100
Mailing Address - Fax:509-925-2008
Practice Address - Street 1:30 W MAIN ST STE 207
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362
Practice Address - Country:US
Practice Address - Phone:509-876-0100
Practice Address - Fax:509-925-2008
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000066681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1124188487OtherNPI ELLENSBURG COUNSELING
WA1124188487OtherNPI ELLENSBURG COUNSELING