Healthcare Provider Details

I. General information

NPI: 1831866813
Provider Name (Legal Business Name): LECHE JUNE BRADSHAW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 N FRESNO ST STE 500
FRESNO CA
93710-6849
US

IV. Provider business mailing address

696 LA DAWNA ST
TULARE CA
93274-2535
US

V. Phone/Fax

Practice location:
  • Phone: 877-418-2978
  • Fax:
Mailing address:
  • Phone: 559-759-8302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-81302
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: