Healthcare Provider Details

I. General information

NPI: 1366871568
Provider Name (Legal Business Name): RYAN BRADLEY LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2917 S RAINIER ST
KENNEWICK WA
99337-3857
US

IV. Provider business mailing address

2917 S RAINIER ST
KENNEWICK WA
99337-3857
US

V. Phone/Fax

Practice location:
  • Phone: 509-261-5595
  • Fax:
Mailing address:
  • Phone: 509-261-5595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60538350
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: