Provider Demographics
NPI:1558762856
Name:BRADLEY, LAWRENCE (LMFT)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 W SAINT GEORGE BLVD
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-1308
Mailing Address - Country:US
Mailing Address - Phone:435-773-8480
Mailing Address - Fax:
Practice Address - Street 1:216 W SAINT GEORGE BLVD
Practice Address - Street 2:SUITE B-3
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-1308
Practice Address - Country:US
Practice Address - Phone:435-773-8480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-06
Last Update Date:2014-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT70746733902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist