Basic Information
| Provider Information | |||||||||
| NPI: | 1265819023 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRADFORD | ||||||||
| FirstName: | RUSTI | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6357 | ||||||||
| Address2: | |||||||||
| City: | OROVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959661357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305880633 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1445 VETERANS MEMORIAL CIR | ||||||||
| Address2: | |||||||||
| City: | YUBA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959933011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308213410 | ||||||||
| FaxNumber: | 5308227514 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2015 | ||||||||
| LastUpdateDate: | 01/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 93872 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 110309 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.