Provider Demographics
NPI:1144585464
Name:KOLANO, BRAD A (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:A
Last Name:KOLANO
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 SILHAVY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-4461
Mailing Address - Country:US
Mailing Address - Phone:219-464-1234
Mailing Address - Fax:
Practice Address - Street 1:505 SILHAVY RD STE 100
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4461
Practice Address - Country:US
Practice Address - Phone:219-464-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006591106H00000X
390200000X
IN35002036A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program