1891197190 NPI number — MRS. DANIELLE H BRADSHAW LMHC, LCPC

Table of content: MRS. DANIELLE H BRADSHAW LMHC, LCPC (NPI 1891197190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891197190 NPI number — MRS. DANIELLE H BRADSHAW LMHC, LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRADSHAW
Provider First Name:
DANIELLE
Provider Middle Name:
H
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMHC, LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIXON
Provider Other First Name:
DANIELLE
Provider Other Middle Name:
HARRINGTON
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMHC, LCPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1891197190
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELBA
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83641-0050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-359-6895
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1983 CANYON RD. S.
Provider Second Line Business Practice Location Address:
STE. 100A
Provider Business Practice Location Address City Name:
MELBA
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83641-0050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-359-6895
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/18/2014

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: 101YP2500X , with the licence number:  LCPC-7323 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: LH60916576 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com