Provider Demographics
NPI:1275563843
Name:BRADSHAW, KATHLEEN SULLIVAN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:SULLIVAN
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:ANNE
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:2018 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-5718
Mailing Address - Country:US
Mailing Address - Phone:865-544-0406
Mailing Address - Fax:
Practice Address - Street 1:2018 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-5718
Practice Address - Country:US
Practice Address - Phone:865-544-0406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0732106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist