Provider Demographics
NPI:1497892467
Name:KINDER, BRADLEY LEE (MA, LP, LMFT)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:LEE
Last Name:KINDER
Suffix:
Gender:M
Credentials:MA, LP, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1895 LAUREL AVE
Mailing Address - Street 2:SUITE #203
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-5938
Mailing Address - Country:US
Mailing Address - Phone:651-647-4944
Mailing Address - Fax:651-646-6176
Practice Address - Street 1:1895 LAUREL AVE
Practice Address - Street 2:SUITE #203
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-5938
Practice Address - Country:US
Practice Address - Phone:651-647-4944
Practice Address - Fax:651-646-6176
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4383103T00000X
MN392106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist