Provider Demographics
NPI:1902427966
Name:BRADLEY, MADISON SHEA (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MADISON
Middle Name:SHEA
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:SHEA
Other - Last Name:MCCUNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2714 JOANEL ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-5304
Mailing Address - Country:US
Mailing Address - Phone:713-402-5046
Mailing Address - Fax:713-626-3667
Practice Address - Street 1:2714 JOANEL ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5304
Practice Address - Country:US
Practice Address - Phone:713-402-5046
Practice Address - Fax:713-626-3667
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80560101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional