Healthcare Provider Details

I. General information

NPI: 1891261327
Provider Name (Legal Business Name): BRADLEY B MILLIKEN LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 ARCH ST
REDWOOD CITY CA
94062-1303
US

IV. Provider business mailing address

308 GREENFIELD AVE
SAN MATEO CA
94403-5012
US

V. Phone/Fax

Practice location:
  • Phone: 650-363-0249
  • Fax: 650-363-0436
Mailing address:
  • Phone: 650-460-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number108161
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: