Provider Demographics
NPI:1821438243
Name:BANDY, BRAD ALLEN
Entity Type:Individual
Prefix:MR
First Name:BRAD
Middle Name:ALLEN
Last Name:BANDY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 NW 43RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-5023
Mailing Address - Country:US
Mailing Address - Phone:405-812-5595
Mailing Address - Fax:
Practice Address - Street 1:1515 NW 43RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-5023
Practice Address - Country:US
Practice Address - Phone:405-812-5595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-29
Last Update Date:2013-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health