Provider Demographics
NPI:1326892589
Name:BRADLEY, TIM D
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:D
Last Name:BRADLEY
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 1:2345 ROYAL PALM DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-7863
Mailing Address - Country:US
Mailing Address - Phone:719-465-6396
Mailing Address - Fax:
Practice Address - Street 1:2345 ROYAL PALM DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-7863
Practice Address - Country:US
Practice Address - Phone:719-465-6396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician