Provider Demographics
NPI:1205053253
Name:BRADLEY, VERNON R (LMFT)
Entity type:Individual
Prefix:MR
First Name:VERNON
Middle Name:R
Last Name:BRADLEY
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:PO BOX 48
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-0048
Mailing Address - Country:US
Mailing Address - Phone:909-797-8325
Mailing Address - Fax:909-797-8208
Practice Address - Street 1:35249 YUCAIPA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-4340
Practice Address - Country:US
Practice Address - Phone:909-797-8325
Practice Address - Fax:909-797-8208
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC17232106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist