Basic Information
| Provider Information | |||||||||
| NPI: | 1619096781 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRADY | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
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| OtherLastName: | BRADY | ||||||||
| OtherFirstName: | CHRISTY | ||||||||
| OtherMiddleName: | L. | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 141 N ARROWHEAD AVE | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924081016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099635355 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 141 N ARROWHEAD AVE | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099635355 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 08/17/2018 | ||||||||
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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 | 106H00000X | LMFT33967 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.