Individual
MARK L BRADBURY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LMFTA
Contact information
Practice address
416 WALNUT ACRES RD, KELSO, WA 98626-9788
(208) 740-4382
Mailing address
416 WALNUT ACRES RD, KELSO, WA 98626-9788
(208) 740-4382
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MG61552309
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2243555
—
WA
Enumeration date
05/01/2023
Last updated
09/02/2024
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