Provider Demographics
NPI:1770638629
Name:LOMBARDI, BRADFORD D (LPC)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:D
Last Name:LOMBARDI
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5368 W JOSH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-5922
Mailing Address - Country:US
Mailing Address - Phone:417-894-0103
Mailing Address - Fax:
Practice Address - Street 1:5368 W JOSH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-5922
Practice Address - Country:US
Practice Address - Phone:417-894-0103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003027608101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional