Provider Demographics
NPI:1689958712
Name:BRADLEY, DIANNE C (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:C
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CONTINENTAL PL STE 204
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1041
Mailing Address - Country:US
Mailing Address - Phone:615-509-7374
Mailing Address - Fax:
Practice Address - Street 1:357 RIVERSIDE DR
Practice Address - Street 2:SUITE 240
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-8963
Practice Address - Country:US
Practice Address - Phone:615-509-7374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN804106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist