Individual ProviderTamara T. BradleySocial WorkerBehavioral Health & Social Service ProvidersPractice Address1675 Curlew Drive, Idaho Falls, ID 83406(208) 529-4300PECOS EnrollmentBased on the most recent information from CMS, provider Tamara T. Bradley does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1770686693Provider TypeIndividualFull NameBradley, Tamara T.TitleMs.CredentialL.C.S.W.GenderFemaleSole ProprietorNoEnumeration Date9/6/2006Last Updated7/8/2007Contact InformationPractice LocationPractice Address1675 Curlew Drive, Idaho Falls, ID 83406Phone(208) 529-4300Fax(208) 529-1627Mailing LocationMailing Address485 Gardner Dr, Blackfoot, ID 83221-3928Phone(208) 529-4300Fax(208) 529-1627Provider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicenseLCSW-1459IdahoProvider IdentifiersIDDescriptionIssuerIDL5089DescriptionOtherIssuerBLUE CROSS OF IDAHOIdahoID000010141602DescriptionOtherIssuerREGENCE BLUE SHIELDIdaho