Provider Demographics
NPI:1235627803
Name:BEDFORD, MICHAEL JUDSON
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JUDSON
Last Name:BEDFORD
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 1:6321 BACH DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-1253
Mailing Address - Country:US
Mailing Address - Phone:513-486-8279
Mailing Address - Fax:
Practice Address - Street 1:6321 BACH DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-1253
Practice Address - Country:US
Practice Address - Phone:513-486-8279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-28
Last Update Date:2018-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)