Provider Demographics
NPI:1215577416
Name:BRADFORD SHERWOOD, EMILY LOUISE (LPC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LOUISE
Last Name:BRADFORD SHERWOOD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-3826
Mailing Address - Country:US
Mailing Address - Phone:228-234-8458
Mailing Address - Fax:
Practice Address - Street 1:707 FOREST AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-3826
Practice Address - Country:US
Practice Address - Phone:228-234-8458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-15
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1481101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional