Provider Demographics
NPI:1386856359
Name:BARDSLEY, ERIC B (MED, LMHC)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:B
Last Name:BARDSLEY
Suffix:
Gender:M
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9922 A CLARA BLVD. S.W.
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-3119
Mailing Address - Country:US
Mailing Address - Phone:253-588-1339
Mailing Address - Fax:253-852-2360
Practice Address - Street 1:1851 CENTRAL PL. S.
Practice Address - Street 2:SUITE 123
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-3119
Practice Address - Country:US
Practice Address - Phone:253-520-7344
Practice Address - Fax:253-852-2360
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003738101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health