Provider Demographics
NPI:1518021294
Name:BRADSHAW, JOHN FRANKLYN (MS,LMFT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FRANKLYN
Last Name:BRADSHAW
Suffix:
Gender:M
Credentials:MS,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 HORSETRAIL WAY
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4605
Mailing Address - Country:US
Mailing Address - Phone:919-497-5400
Mailing Address - Fax:919-497-5407
Practice Address - Street 1:215 S BICKETT BLVD
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2607
Practice Address - Country:US
Practice Address - Phone:919-497-4500
Practice Address - Fax:919-497-5407
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1049106H00000X
OHF0070106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105034Medicaid
NC13884OtherBLUE CROSS BLUE SHIELD