MEDICARE: MR. BRADLEY PETER SHORE MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	94691	CA

General Provider Information

NPI Number	:	1730030198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRADLEY PETER SHORE MFT

Provider Business Mailing Address
First Line	:	2662 E 2ND ST UNIT J3
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-5199
Country	:	US
Telephone Number	:	562-225-6548
Fax Number	:

Provider Business Practice Location Address
First Line	:	3233 E BROADWAY STE 18
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-5817
Country	:	US
Telephone Number	:	562-225-6548
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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