Provider Demographics
NPI:1346531407
Name:SIGAFOOSE, BRADLEY E (LPC)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:E
Last Name:SIGAFOOSE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7320 SW HUNZIKER RD STE 204
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2301
Mailing Address - Country:US
Mailing Address - Phone:971-222-8166
Mailing Address - Fax:866-802-8062
Practice Address - Street 1:7320 SW HUNZIKER RD STE 204
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-2301
Practice Address - Country:US
Practice Address - Phone:971-222-8166
Practice Address - Fax:866-802-8062
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3392101Y00000X
WI5862-125101YM0800X
MI6401012431101YP2500X
ORC4852101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health