Provider Demographics
NPI:1750515052
Name:BRADSHAW, CHRISTINE T (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:T
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MISS
Other - First Name:CHRISTINE
Other - Middle Name:MASON
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5470 JACKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-1236
Mailing Address - Country:US
Mailing Address - Phone:713-668-6012
Mailing Address - Fax:
Practice Address - Street 1:5470 JACKWOOD ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-1236
Practice Address - Country:US
Practice Address - Phone:713-668-6012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23325103TC0700X
TX6625103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool