Provider Demographics
NPI:1245560978
Name:BRADLEY, JASMINE BROOKE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:BROOKE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 E CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-6002
Mailing Address - Country:US
Mailing Address - Phone:925-876-9356
Mailing Address - Fax:
Practice Address - Street 1:1418 E CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-6002
Practice Address - Country:US
Practice Address - Phone:925-876-9356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3178103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist