Provider Demographics
NPI:1598836447
Name:BRADLEY, DENISE LYNN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:LYNN
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5219 MCPHERSON RD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-7306
Mailing Address - Country:US
Mailing Address - Phone:956-717-0705
Mailing Address - Fax:956-791-3443
Practice Address - Street 1:5219 MCPHERSON RD
Practice Address - Street 2:SUITE 402
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-7306
Practice Address - Country:US
Practice Address - Phone:956-717-0705
Practice Address - Fax:956-791-3443
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15925101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor