Provider Demographics
NPI:1427591940
Name:BRADFORD-THOMAS, EBONY
Entity Type:Individual
Prefix:MRS
First Name:EBONY
Middle Name:
Last Name:BRADFORD-THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10046 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1926
Mailing Address - Country:US
Mailing Address - Phone:773-429-0300
Mailing Address - Fax:773-429-0200
Practice Address - Street 1:10046 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1926
Practice Address - Country:US
Practice Address - Phone:773-429-0300
Practice Address - Fax:773-429-0200
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health