Provider Demographics
NPI:1114780574
Name:BRADFORD, BRIAN J (LPC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:J
Last Name:BRADFORD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 CAMBRIAN RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-4822
Mailing Address - Country:US
Mailing Address - Phone:205-567-1201
Mailing Address - Fax:
Practice Address - Street 1:300 CENTURY PARK S STE 100
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35226-3924
Practice Address - Country:US
Practice Address - Phone:205-547-2721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLPC05048101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional