Provider Demographics
NPI:1437381720
Name:MCCONNELL, BRADLEY JAMES (PSYD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:JAMES
Last Name:MCCONNELL
Suffix:
Gender:M
Credentials:PSYD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 W DIMOND BLVD UNIT 302
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-1555
Mailing Address - Country:US
Mailing Address - Phone:661-805-7908
Mailing Address - Fax:888-974-1145
Practice Address - Street 1:3550 W DIMOND BLVD UNIT 302
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-1555
Practice Address - Country:US
Practice Address - Phone:661-805-7908
Practice Address - Fax:888-974-1145
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK144849103TC0700X
WAPY60340131103TC0700X
CAPSY26922103TC0700X
VA0810004895103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1711270Medicaid