Provider Demographics
NPI:1194841536
Name:BRADFORD, BRIAN EUGENE (QMHA BA)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:EUGENE
Last Name:BRADFORD
Suffix:
Gender:M
Credentials:QMHA BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88049 LLAMA LN
Mailing Address - Street 2:
Mailing Address - City:VENETA
Mailing Address - State:OR
Mailing Address - Zip Code:97487-8732
Mailing Address - Country:US
Mailing Address - Phone:541-913-7633
Mailing Address - Fax:
Practice Address - Street 1:20 E 13TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3535
Practice Address - Country:US
Practice Address - Phone:541-913-7633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)