Individual
MS. MARY K BRADSHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
1508 GREENUP AVE, STE 1, ASHLAND, KY 41101-7614
(859) 254-1035
(859) 254-2075
Mailing address
900 BEASLEY ST, STE 120, LEXINGTON, KY 40509-4266
(859) 254-1035
(859) 254-2075
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
104911
KY
163WP0808X
Psychiatric/Mental Health Registered Nurse
104911
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30615058
—
KY
05
—
7100391530
—
KY
Enumeration date
11/07/2006
Last updated
03/22/2017
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