Provider Demographics
NPI:1508995192
Name:LARNER, BRADLEY A (MA, CAC I)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:A
Last Name:LARNER
Suffix:
Gender:M
Credentials:MA, CAC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 WYNES ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-3752
Mailing Address - Country:US
Mailing Address - Phone:989-249-4966
Mailing Address - Fax:
Practice Address - Street 1:6379 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:MI
Practice Address - Zip Code:48722-9566
Practice Address - Country:US
Practice Address - Phone:989-777-4357
Practice Address - Fax:989-777-7257
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)