Provider Demographics
NPI:1265014419
Name:HARBISON, BRADIE (MED, LCDC, LPC)
Entity Type:Individual
Prefix:
First Name:BRADIE
Middle Name:
Last Name:HARBISON
Suffix:
Gender:F
Credentials:MED, LCDC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 LOUIS HENNA BLVD APT 7306
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7561
Mailing Address - Country:US
Mailing Address - Phone:512-508-3229
Mailing Address - Fax:
Practice Address - Street 1:650 LOUIS HENNA BLVD APT 7306
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7561
Practice Address - Country:US
Practice Address - Phone:512-508-3229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15045101YA0400X
TX81007101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)