Active NPI
Katrina Bradshaw
- Marriage & Family Therapist
- San Luis Obispo, CA
National Provider Identifier
1255694808
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- Practice address
- 2178 Johnson Ave
San Luis Obispo, CA 93401-4535 - Phone
- (480) 335-4503
- NPI assigned
- Jun 19, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Marriage & Family Therapist | 106H00000X | Primary |
Addresses
Primary practice location
2178 Johnson Ave
San Luis Obispo, CA 93401-4535
Mailing address
3765 S Higuera St Ste 100
San Luis Obispo, CA 93401-1577
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475539200000",
"number": "1255694808",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3765 S HIGUERA ST STE 100",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934011577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2178 JOHNSON AVE",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934014535",
"telephone_number": "480-335-4503"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADSHAW",
"first_name": "KATRINA",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-19",
"last_updated": "2016-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Luis Obispo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.