Provider Demographics
NPI:1346386554
Name:BRADY, TIMOTHY H (LISW, LMFT)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:H
Last Name:BRADY
Suffix:
Gender:M
Credentials:LISW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 CHESTNUT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45693-9584
Mailing Address - Country:US
Mailing Address - Phone:937-544-5581
Mailing Address - Fax:937-544-7327
Practice Address - Street 1:192 CHESTNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-9584
Practice Address - Country:US
Practice Address - Phone:937-544-5581
Practice Address - Fax:937-544-7327
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00015031041C0700X
OHF0000071106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBR2022791Medicare ID - Type Unspecified