Provider Demographics
NPI:1023741956
Name:BRADWAY, ALYSE (LMFTA)
Entity type:Individual
Prefix:
First Name:ALYSE
Middle Name:
Last Name:BRADWAY
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 N 63RD ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-5400
Mailing Address - Country:US
Mailing Address - Phone:303-907-1247
Mailing Address - Fax:
Practice Address - Street 1:4001 NE 50TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-2942
Practice Address - Country:US
Practice Address - Phone:833-557-1098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program