Provider Demographics
NPI:1578766929
Name:BRADFORD, TANISHA WANJIRA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TANISHA
Middle Name:WANJIRA
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:TANISHA
Other - Middle Name:WANJIRA
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6500 HORNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-5008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25234 DIAMOND RANCH DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-4963
Practice Address - Country:US
Practice Address - Phone:281-638-5741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS362581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical