Provider Demographics
NPI:1356571855
Name:BRUSH, BRADLEY BERNARD (MA, LPC, NCC)
Entity type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:BERNARD
Last Name:BRUSH
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1864. N. NORWOOD DR., STE. D.
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054
Mailing Address - Country:US
Mailing Address - Phone:817-391-0771
Mailing Address - Fax:
Practice Address - Street 1:1864 N. NORWOOD DR., STE. D.
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054
Practice Address - Country:US
Practice Address - Phone:817-391-0771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14329101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional