Provider Demographics
NPI:1710921283
Name:BRADLEY, AMBER RENEE (MS, LMHP, NCC)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:RENEE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MS, LMHP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 S 132ND ST
Mailing Address - Street 2:#122
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3409
Mailing Address - Country:US
Mailing Address - Phone:402-480-4819
Mailing Address - Fax:402-763-9435
Practice Address - Street 1:11912 ELM ST
Practice Address - Street 2:#117
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4363
Practice Address - Country:US
Practice Address - Phone:402-480-4819
Practice Address - Fax:402-764-9435
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2978101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health