Provider Demographics
NPI:1881979219
Name:HILLBRADSHAW, BEVERLY ANN (MS, LADC)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:ANN
Last Name:HILLBRADSHAW
Suffix:
Gender:F
Credentials:MS, LADC
Other - Prefix:MRS
Other - First Name:BEVERLY
Other - Middle Name:ANN
Other - Last Name:HILLBRADSHAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LADC
Mailing Address - Street 1:5185 CAMINO AL NORTE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2415
Mailing Address - Country:US
Mailing Address - Phone:702-522-9962
Mailing Address - Fax:
Practice Address - Street 1:5185 CAMINO AL NORTE
Practice Address - Street 2:SUITE 130
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2415
Practice Address - Country:US
Practice Address - Phone:702-522-9962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV826-L251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health