Provider Demographics
NPI:1902373798
Name:BRAGDON, SIDNEY (AMFT)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:
Last Name:BRAGDON
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 E CANAL DR
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-3901
Mailing Address - Country:US
Mailing Address - Phone:209-669-2577
Mailing Address - Fax:
Practice Address - Street 1:2513 YOUNGSTOWN RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-9707
Practice Address - Country:US
Practice Address - Phone:209-669-2577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132270106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist