Provider Demographics
NPI:1689860470
Name:BRADSHAW, VESTER LENELL JR (LMFI)
Entity Type:Individual
Prefix:
First Name:VESTER
Middle Name:LENELL
Last Name:BRADSHAW
Suffix:JR
Gender:M
Credentials:LMFI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9113
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93389-9113
Mailing Address - Country:US
Mailing Address - Phone:661-340-9490
Mailing Address - Fax:
Practice Address - Street 1:4900 CALIFORNIA AVE TOWER A SUITE 200
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309
Practice Address - Country:US
Practice Address - Phone:619-614-1184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFTI 62836106H00000X
171M00000X
CA106528106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator