Spencer D. Bradshaw, LMFTA, PHD

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

201891 Issued in TX

Practice address

8200 Nashville Ave
Lubbock, TX 79423-1906

Phone

(801) 450-6936

NPI assigned

Mar 14, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Dec 5, 2024 through Dec 5, 2026

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Systems-Based Therapy, PLLC

  • Marriage & Family Therapist
  • Logan, UT
  • NPI 1477366904
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1520985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520985600000",
    "number": "1790288934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 LONGHORN BLVD",
            "city": "WOLFFORTH",
            "state": "TX",
            "postal_code": "793825315",
            "telephone_number": "801-450-6936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8200 NASHVILLE AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794231906",
            "telephone_number": "801-450-6936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADSHAW",
        "first_name": "SPENCER",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "LMFTA, PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-03-14",
        "last_updated": "2018-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "TX",
            "license": "201891",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Thomas Bradley, M.D.
• Jay Cameron Bradley, M.D.
• Loretta Jean Bradley, PHD
• Carol Bradshaw, RDN, LD
• Evan Bradshaw, MD
• Curtis W Brady, FNP-C
• Hannah Brady
• Rika Methola Brake, OT
• Shelby Dean Brake, LPC
• Gary Alan Branch, P.PH.

• Marriage & Family Therapist in Lubbock, TX
• Providers in Lubbock, TX by specialty
• Marriage & Family Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.