Provider Demographics
NPI:1619451911
Name:BRADLEY, LAUREN (LPC, CD(DONA))
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LPC, CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75602-1516
Mailing Address - Country:US
Mailing Address - Phone:903-738-3257
Mailing Address - Fax:
Practice Address - Street 1:212 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75602-1516
Practice Address - Country:US
Practice Address - Phone:903-738-3257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70966101Y00000X
TX12408374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No374J00000XNursing Service Related ProvidersDoula