Provider Demographics
NPI:1407204308
Name:WHITE, BRADFORD JAMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:JAMES
Last Name:WHITE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 E BROADWAY ST STE 7
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-2935
Mailing Address - Country:US
Mailing Address - Phone:424-242-2723
Mailing Address - Fax:
Practice Address - Street 1:212 E BROADWAY ST STE 7
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-2935
Practice Address - Country:US
Practice Address - Phone:424-242-2723
Practice Address - Fax:469-208-9254
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37415103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist