Provider Demographics
NPI:1811213713
Name:BRADSHAW COUNSELING SERVICES
Entity Type:Organization
Organization Name:BRADSHAW COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BRADSHAW MACLYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-803-7590
Mailing Address - Street 1:2171 TORRANCE BLVD
Mailing Address - Street 2:SUITE # 5
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2635
Mailing Address - Country:US
Mailing Address - Phone:310-803-7590
Mailing Address - Fax:310-783-0223
Practice Address - Street 1:2171 TORRANCE BLVD
Practice Address - Street 2:SUITE # 5
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-2635
Practice Address - Country:US
Practice Address - Phone:310-803-7590
Practice Address - Fax:310-783-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT23852106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty