Provider Demographics
NPI:1629568027
Name:BRADSHAW COUNSELING AND CONSULTATION SERVICES LLC
Entity Type:Organization
Organization Name:BRADSHAW COUNSELING AND CONSULTATION SERVICES LLC
Other - Org Name:WILLOW TREE COUNSELING AND CONSULTATION SERVICES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:877-994-5569
Mailing Address - Street 1:3 RIVER OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4503
Mailing Address - Country:US
Mailing Address - Phone:501-322-9541
Mailing Address - Fax:
Practice Address - Street 1:1141 E MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-3014
Practice Address - Country:US
Practice Address - Phone:877-994-5569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1411090261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health