Provider Demographics
NPI:1093935603
Name:DECKER, BRADLEY DEAN (LADC)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:DEAN
Last Name:DECKER
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:BRADLEY
Other - Middle Name:DEAN
Other - Last Name:DECKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:7420 S 29TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5738
Mailing Address - Country:US
Mailing Address - Phone:402-310-6690
Mailing Address - Fax:402-423-2643
Practice Address - Street 1:7420 S 29TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5738
Practice Address - Country:US
Practice Address - Phone:402-310-6690
Practice Address - Fax:402-423-2643
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1474101YA0400X
NE862225700000X
NE1444101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist