Provider Demographics
NPI:1689984866
Name:BRADFORD, KYMBERLY YVETTE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KYMBERLY
Middle Name:YVETTE
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:LPC
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 5093
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71211-5093
Mailing Address - Country:US
Mailing Address - Phone:318-669-1061
Mailing Address - Fax:318-325-5385
Practice Address - Street 1:4951 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-6156
Practice Address - Country:US
Practice Address - Phone:318-340-7535
Practice Address - Fax:318-340-1539
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC232194101Y00000X
LA3686101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor