Provider Demographics
NPI:1891261327
Name:MILLIKEN, BRADLEY B (LMFT)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:B
Last Name:MILLIKEN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-5012
Mailing Address - Country:US
Mailing Address - Phone:650-460-7575
Mailing Address - Fax:
Practice Address - Street 1:165 ARCH ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1303
Practice Address - Country:US
Practice Address - Phone:650-363-0249
Practice Address - Fax:650-363-0436
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108161101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional