1043229321 NPI number — MRS. PATRICIA KAY BRADFORD M.ED., LPC, MT-BC

Table of content: MRS. PATRICIA KAY BRADFORD M.ED., LPC, MT-BC (NPI 1043229321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043229321 NPI number — MRS. PATRICIA KAY BRADFORD M.ED., LPC, MT-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRADFORD
Provider First Name:
PATRICIA
Provider Middle Name:
KAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED., LPC, MT-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRADFORD
Provider Other First Name:
TRICIA
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED., LPC, MT-BC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1043229321
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6910 W 45TH AVE
Provider Second Line Business Mailing Address:
SUITE 23
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79109-5078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-355-7755
Provider Business Mailing Address Fax Number:
806-355-6842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6910 W 45TH AVE
Provider Second Line Business Practice Location Address:
SUITE 23
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79109-5078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-355-7755
Provider Business Practice Location Address Fax Number:
806-355-6842
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  14142 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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