Provider Demographics
NPI:1780703371
Name:BRADLEY, LINDELL (MD)
Entity type:Individual
Prefix:DR
First Name:LINDELL
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LINDELL
Other - Middle Name:
Other - Last Name:BRADLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 20328
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89515-0328
Mailing Address - Country:US
Mailing Address - Phone:775-825-2777
Mailing Address - Fax:775-285-6090
Practice Address - Street 1:2345 E PRATER WAY STE 102
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-9664
Practice Address - Country:US
Practice Address - Phone:775-825-2777
Practice Address - Fax:775-825-6090
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVVMD7703Medicare ID - Type Unspecified