Provider Demographics
NPI:1679899744
Name:BRADSHAW, SHIRLEY DIAN (LMHC)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:DIAN
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 S PATRICK DR
Mailing Address - Street 2:#24
Mailing Address - City:SATELLITE BCH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3939
Mailing Address - Country:US
Mailing Address - Phone:321-773-1111
Mailing Address - Fax:
Practice Address - Street 1:1127 S PATRICK DR
Practice Address - Street 2:#24
Practice Address - City:SATELLITE BCH
Practice Address - State:FL
Practice Address - Zip Code:32937-3939
Practice Address - Country:US
Practice Address - Phone:321-773-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9333101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health