MEDICARE: TIERRA RENE BRADLEY

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1750853883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIERRA RENE BRADLEY

Provider Business Mailing Address
First Line	:	6501 DUCK HILL SPRINGS DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-3509
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 PECOS MCLEOD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4259
Country	:	US
Telephone Number	:	702-335-5714
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIERRA BRADLEY
Credential	:
Telephone Number	:	702-335-5714

Provider Enumeration Date	:	12/31/2018
Last Update Date	:	12/31/2018

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Directions to “TIERRA RENE BRADLEY ” Practice Location

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