Provider Demographics
NPI:1245924851
Name:BRADSHAW, TONYA ANNETTE (LPC)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:ANNETTE
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:
Other - Last Name:HURRINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1116 STONE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2852
Mailing Address - Country:US
Mailing Address - Phone:972-822-6619
Mailing Address - Fax:
Practice Address - Street 1:1116 STONE RIDGE LN
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2852
Practice Address - Country:US
Practice Address - Phone:972-822-6619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
85257101YM0800X
TX85257101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health