Individual
MISS KEANA ROSE BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHRS
Contact information
Practice address
1234 EMPIRE ST, FAIRFIELD, CA 94533-5711
(707) 429-4440
Mailing address
1234 EMPIRE ST, FAIRFIELD, CA 94533-5711
(707) 429-4440
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
15412
CA
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
—
—
Other
Enumeration date
09/12/2016
Last updated
12/30/2025
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