Individual
KEITH ALLEN BRADSHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
18750 N 6750 E, MOUNT PLEASANT, UT 84647-2309
(801) 375-4240
(801) 375-4241
Mailing address
619 N 500 W, PROVO, UT 84601-1547
(801) 420-0465
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
04/28/2014
Last updated
04/28/2014
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