Provider Demographics
NPI:1922516145
Name:BRADLEY, KEANA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KEANA
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2919 BARCO
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-5542
Mailing Address - Country:US
Mailing Address - Phone:214-801-5499
Mailing Address - Fax:214-801-5499
Practice Address - Street 1:2919 BARCO
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75054-5542
Practice Address - Country:US
Practice Address - Phone:214-801-5499
Practice Address - Fax:214-801-5499
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67902101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional