Individual
MARY A BRADMILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
701 PARK AVE, MINNEAPOLIS, MN 55415-1623
(612) 873-2300
(612) 904-4261
Mailing address
701 PARK AVE, MINNEAPOLIS, MN 55415-1623
(612) 873-6005
(612) 630-8242
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP4152
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106693500
—
MN
01
—
152297
BEHAVIORAL HEALTHCARE
MN
01
—
61-56228
UNITED BEHAVIORAL HEALTH
MN
Enumeration date
07/18/2006
Last updated
11/10/2020
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