Provider Demographics
NPI:1376304360
Name:BRADFORD, AMBER NICOLE (MED)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2129 FM 2920 STE 190
Mailing Address - Street 2:#136
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388
Mailing Address - Country:US
Mailing Address - Phone:936-215-9023
Mailing Address - Fax:
Practice Address - Street 1:2129 FM 2920 RD STE 190-136
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-3671
Practice Address - Country:US
Practice Address - Phone:936-215-9023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87085101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional