| NPI | 1811106644 |
|---|---|
| Former Name | HEATHER R. BRADSHAW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MO 2008034835) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE 8291) |
| 101YM0800X Counselor Mental Health (Licence: MO 2008019412) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2011-06-17 |