Provider Demographics
NPI:1295480556
Name:BRADLEY, RUTH ESMERALDA (LPC)
Entity type:Individual
Prefix:MS
First Name:RUTH
Middle Name:ESMERALDA
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:RUTH
Other - Middle Name:ESMERALDA
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:1014 E HIGHWAY 82 STE 232
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-2721
Mailing Address - Country:US
Mailing Address - Phone:956-402-6463
Mailing Address - Fax:
Practice Address - Street 1:1115 MEMORIAL DR STE 103
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-2034
Practice Address - Country:US
Practice Address - Phone:903-462-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79274101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional