Provider Demographics
NPI:1376969014
Name:BRADRICK, ERIN (MA,LMHC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BRADRICK
Suffix:
Gender:F
Credentials:MA,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12323 NE 97TH ST
Mailing Address - Street 2:APT A
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5869
Mailing Address - Country:US
Mailing Address - Phone:253-682-7725
Mailing Address - Fax:
Practice Address - Street 1:6712 KIMBALL DR
Practice Address - Street 2:#103
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1212
Practice Address - Country:US
Practice Address - Phone:253-858-2224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60129963101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH 60129963OtherMENTAL HEALTH COUNSELOR LICENSE