Provider Demographics
NPI:1225297336
Name:WILLIAMS, BRADFORD GRANT
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:GRANT
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 NORTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1533
Mailing Address - Country:US
Mailing Address - Phone:330-723-9600
Mailing Address - Fax:330-722-1446
Practice Address - Street 1:246 NORTHLAND DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1533
Practice Address - Country:US
Practice Address - Phone:330-723-9600
Practice Address - Fax:330-722-1446
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3335103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist