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General NPI Number Information
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NPI Number | 1881848265
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Entity Type | Individual
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Provider Name | IAN WILLIAM BRADSHAW LPC
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Gender | Male
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Dates
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Enumeration Date | 11/11/2008
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Last Update Date | 05/11/2018
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Provider Practice Location Address
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Address Line | 1141 E MAIN ST STE 200
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City | BATESVILLE
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State | AR
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Zip | 72501-3014
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Country | US
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Telephone | 877-994-5569
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Fax |
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Provider Business Mailing Address
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Address Line | 3 RIVER OAKS BLVD
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City | SEARCY
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State | AR
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Zip | 72143-4503
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Country | US
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Telephone | 501-322-9541
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P1411090
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P1411090
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License Number State | AR
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