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General NPI Number Information
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NPI Number | 1750853883
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Entity Type | Organization
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Legal Business Name | TIERRA RENE BRADLEY
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Dates
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Enumeration Date | 12/31/2018
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Last Update Date | 12/31/2018
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Provider Practice Location Address
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Address Line | 3700 PECOS MCLEOD STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89121-4259
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Country | US
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Telephone | 702-335-5714
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Fax |
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Provider Business Mailing Address
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Address Line | 6501 DUCK HILL SPRINGS DR
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City | LAS VEGAS
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State | NV
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Zip | 89122-3509
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIERRA BRADLEY
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Credential |
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Telephone | 702-335-5714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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