Active NPI
Blaire Bradbury, LAC
- Professional Counselor
- Fayetteville, AR
National Provider Identifier
1568069169
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- A2009127
- Practice address
- 1466 N Desoto PL
Fayetteville, AR 72703-1953 - Phone
- (479) 544-1202
- NPI assigned
- Oct 6, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | A2009127 | AR | Primary |
Addresses
Primary practice location
1466 N Desoto PL
Fayetteville, AR 72703-1953
Mailing address
1466 N Desoto PL
Fayetteville, AR 72703-1953
Phone (479) 544-1202
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A2009127 | AR | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1601942400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601942400000",
"number": "1568069169",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1466 N DESOTO PL",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727031953",
"telephone_number": "479-544-1202"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1466 N DESOTO PL",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727031953",
"telephone_number": "479-544-1202"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADBURY",
"first_name": "BLAIRE",
"credential": "LAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-10-06",
"last_updated": "2020-10-06",
"certification_date": "2020-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "AR",
"license": "A2009127",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, AR
- Katie Boydstun, LCSW
- Jeana Nicole Boyette, MHPP
- Amanda E Brackett, APN
- Brian Keith Bracy, M.D.
- Brad H. Green D.D.S., P.a.
- Erin Elizabeth Bradford, MS, OTR/L
- Makenzie Faith Bradford, OT
- Thomas Hal Bradford, MD
- Bradley R Crossfield DDS of Northwest Arkansas PLLC (Tooth Squad Pediatric Dentistry)
- Amy Grace Bradley, M.S, CCC-SLP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.