Provider Demographics
NPI:1609000173
Name:PRICE, BRADFORD HETZLER (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:HETZLER
Last Name:PRICE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4461 TIMBERDALE DR
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-1831
Mailing Address - Country:US
Mailing Address - Phone:330-689-0910
Mailing Address - Fax:
Practice Address - Street 1:908 SAHARA TRAIL
Practice Address - Street 2:SUITE 2
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-3667
Practice Address - Country:US
Practice Address - Phone:330-726-2965
Practice Address - Fax:330-726-0449
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH862275101YA0400X
OHC 0500197101YM0800X, 101YP2500X
101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral