Provider Demographics
NPI:1437664455
Name:WARD, BRADLEY OWEN (MA/LPCC)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:OWEN
Last Name:WARD
Suffix:
Gender:M
Credentials:MA/LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2242 OLYMPIC ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2737
Mailing Address - Country:US
Mailing Address - Phone:937-390-7773
Mailing Address - Fax:937-390-8765
Practice Address - Street 1:2242 OLYMPIC ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2737
Practice Address - Country:US
Practice Address - Phone:937-390-7773
Practice Address - Fax:937-390-8765
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE2203235101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional