Provider Demographics
NPI:1902919384
Name:STREETMAN, JOE BRADLEY (PHD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:BRADLEY
Last Name:STREETMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 COLUMBIA POINT DR STE 201-B
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4346
Mailing Address - Country:US
Mailing Address - Phone:509-628-4091
Mailing Address - Fax:
Practice Address - Street 1:400 COLUMBIA POINT DR STE 201-B
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4346
Practice Address - Country:US
Practice Address - Phone:509-628-4091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2063101YP2500X
WALH00010833101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR171037Medicaid