Provider Demographics
NPI:1174868715
Name:BRADLEY, FRANCIS LUKE
Entity type:Individual
Prefix:
First Name:FRANCIS
Middle Name:LUKE
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 NW SOUTH SHORE DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-1440
Mailing Address - Country:US
Mailing Address - Phone:816-225-2667
Mailing Address - Fax:
Practice Address - Street 1:1106 NW SOUTH SHORE DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-1440
Practice Address - Country:US
Practice Address - Phone:816-225-2667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-08
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMLP 2442103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist