Provider Demographics
NPI:1902132293
Name:BRADFORD, MICHELLE RAE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RAE
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:RAE
Other - Last Name:MCGINNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:205 SHIVLER RD
Mailing Address - Street 2:
Mailing Address - City:HOOKSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15050-1726
Mailing Address - Country:US
Mailing Address - Phone:724-630-0995
Mailing Address - Fax:
Practice Address - Street 1:205 SHIVLER RD
Practice Address - Street 2:
Practice Address - City:HOOKSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15050-1726
Practice Address - Country:US
Practice Address - Phone:724-630-0995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005248101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor