Provider Demographics
NPI:1730787011
Name:BRADFIELD, JESSICA (MED, LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BRADFIELD
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 KENDALL CV
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:TX
Mailing Address - Zip Code:78621-5825
Mailing Address - Country:US
Mailing Address - Phone:760-628-8475
Mailing Address - Fax:
Practice Address - Street 1:601 FARLEY DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-3114
Practice Address - Country:US
Practice Address - Phone:512-504-7381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional