Provider Demographics
NPI:1508047978
Name:BRADBURY, KIRSTEN ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:ELIZABETH
Last Name:BRADBURY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3906 N LAMAR BLVD
Mailing Address - Street 2:SUITE 204-D
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-4025
Mailing Address - Country:US
Mailing Address - Phone:512-745-6176
Mailing Address - Fax:
Practice Address - Street 1:3906 N LAMAR BLVD
Practice Address - Street 2:SUITE 204-D
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-4025
Practice Address - Country:US
Practice Address - Phone:512-745-6176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33639103TC0700X, 103TC2200X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth