Provider Demographics
NPI:1730490038
Name:BRADLEY, SAMANTHA MARIE (LIMHP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MARIE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 BURLINGTON ST
Mailing Address - Street 2:PO BOX 683
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-2177
Mailing Address - Country:US
Mailing Address - Phone:308-995-6691
Mailing Address - Fax:308-995-6830
Practice Address - Street 1:710 BURLINGTON ST
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-2177
Practice Address - Country:US
Practice Address - Phone:308-995-6691
Practice Address - Fax:308-995-6830
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9143101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional