Provider Demographics
NPI:1649551227
Name:GALVIN, BRADLEY ROSS (MS, LMHC, CDP)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:ROSS
Last Name:GALVIN
Suffix:
Gender:M
Credentials:MS, LMHC, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 KWINA RD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-9291
Mailing Address - Country:US
Mailing Address - Phone:360-312-2216
Mailing Address - Fax:360-380-6976
Practice Address - Street 1:2665 KWINA RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-9291
Practice Address - Country:US
Practice Address - Phone:360-312-2216
Practice Address - Fax:360-380-6976
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00006293101YA0400X
WALH60486511101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)