MEDICARE: COURTNEY ELIZABETH BRADSHAW APCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist
2	171M00000X	Case Manager/Care Coordinator
3	101YM0800X	Mental Health Counselor	APCC11813	CA

General Provider Information

NPI Number	:	1659737252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY ELIZABETH BRADSHAW APCC

Provider Business Mailing Address
First Line	:	6800 INDIANA AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-4269
Country	:	US
Telephone Number	:	951-666-0019
Fax Number	:

Provider Business Practice Location Address
First Line	:	6800 INDIANA AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-4269
Country	:	US
Telephone Number	:	951-666-0019
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2016
Last Update Date	:	10/31/2022

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