Provider Demographics
NPI:1346315405
Name:BRADLEY K. LAMBSON, PLLC
Entity Type:Organization
Organization Name:BRADLEY K. LAMBSON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:LAMBSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:763-755-7033
Mailing Address - Street 1:13055 RIVERDALE DR NW
Mailing Address - Street 2:SUITE 500 PMB 106
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-8403
Mailing Address - Country:US
Mailing Address - Phone:763-755-7033
Mailing Address - Fax:763-755-7043
Practice Address - Street 1:1635 COON RAPIDS BLVD NW
Practice Address - Street 2:SUITE 220
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-4779
Practice Address - Country:US
Practice Address - Phone:763-755-7033
Practice Address - Fax:763-755-7043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1149106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty