Provider Demographics
NPI:1891197190
Name:BRADSHAW, DANIELLE H (LMHC, LCPC)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:H
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:LMHC, LCPC
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:HARRINGTON
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC, LCPC
Mailing Address - Street 1:PO BOX B
Mailing Address - Street 2:
Mailing Address - City:MELBA
Mailing Address - State:ID
Mailing Address - Zip Code:83641-0050
Mailing Address - Country:US
Mailing Address - Phone:425-359-6895
Mailing Address - Fax:
Practice Address - Street 1:1983 CANYON RD. S.
Practice Address - Street 2:STE. 100A
Practice Address - City:MELBA
Practice Address - State:ID
Practice Address - Zip Code:83641-0050
Practice Address - Country:US
Practice Address - Phone:425-359-6895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-7323101YP2500X
WALH60916576101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional