Basic Information
| Provider Information | |||||||||
| NPI: | 1376969014 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRADRICK | ||||||||
| FirstName: | ERIN | ||||||||
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| Credential: | MA.,LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12323 NE 97TH ST | ||||||||
| Address2: | APT A | ||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980335869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536827725 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6712 KIMBALL DR | ||||||||
| Address2: | #103 | ||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983351212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538582224 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2014 | ||||||||
| LastUpdateDate: | 03/05/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LH 60129963 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | LH 60129963 | 01 | WA | MENTAL HEALTH COUNSELOR LICENSE | OTHER |