Provider Demographics
NPI:1306381025
Name:BRADSHAW, TEKEYA A (LPC-IT)
Entity Type:Individual
Prefix:MRS
First Name:TEKEYA
Middle Name:A
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8031 W GRANTOSA DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-3622
Mailing Address - Country:US
Mailing Address - Phone:414-698-8782
Mailing Address - Fax:
Practice Address - Street 1:8031 W GRANTOSA DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-3622
Practice Address - Country:US
Practice Address - Phone:414-698-8782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3286-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional