Provider Demographics
NPI:1225716202
Name:BRADLEY, SHAINA NICOLE (LSW)
Entity Type:Individual
Prefix:
First Name:SHAINA
Middle Name:NICOLE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 EVERETT LN
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-8403
Mailing Address - Country:US
Mailing Address - Phone:812-698-9333
Mailing Address - Fax:812-254-4801
Practice Address - Street 1:300 NE 14TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-2137
Practice Address - Country:US
Practice Address - Phone:812-254-2760
Practice Address - Fax:812-254-4801
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101YA0400X
IN33011500A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)