Provider Demographics
NPI:1700559655
Name:THOMASSIAN, BRADLEIGH E (MA, LPC-MHSP)
Entity Type:Individual
Prefix:MRS
First Name:BRADLEIGH
Middle Name:E
Last Name:THOMASSIAN
Suffix:
Gender:F
Credentials:MA, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9228 LAWFORD WAY APT 204
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-4462
Mailing Address - Country:US
Mailing Address - Phone:423-368-8077
Mailing Address - Fax:
Practice Address - Street 1:6400 LEE HWY STE 106
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2452
Practice Address - Country:US
Practice Address - Phone:423-855-0402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional