Provider Demographics
NPI:1710610373
Name:BRADFORD, MARIJOSEPHE PIERRE (LPC)
Entity Type:Individual
Prefix:
First Name:MARIJOSEPHE
Middle Name:PIERRE
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 1:505 S LA GRANGE RD FL 2
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6746
Mailing Address - Country:US
Mailing Address - Phone:708-860-7204
Mailing Address - Fax:
Practice Address - Street 1:505 S LA GRANGE RD FL 2
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6746
Practice Address - Country:US
Practice Address - Phone:708-860-7204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178018121101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL178018121OtherLICENSED PROFESSIONAL COUNSELORS - IDFPR