Provider Demographics
NPI:1881848265
Name:BRADSHAW, IAN WILLIAM (LPC)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:WILLIAM
Last Name:BRADSHAW
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 RIVER OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4503
Mailing Address - Country:US
Mailing Address - Phone:501-322-9541
Mailing Address - Fax:
Practice Address - Street 1:1141 E MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-3014
Practice Address - Country:US
Practice Address - Phone:877-994-5569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1411090101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health