Provider Demographics
NPI:1346521903
Name:BRADLEY, MARY C (LCDC, LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LCDC, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1934 CAROLINE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8210
Mailing Address - Country:US
Mailing Address - Phone:713-286-6000
Mailing Address - Fax:713-286-6093
Practice Address - Street 1:1934 CAROLINE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8210
Practice Address - Country:US
Practice Address - Phone:713-286-6000
Practice Address - Fax:713-286-6093
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2927101YA0400X
TX001122106H00000X
TX9398101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist