Provider Demographics
NPI:1922015775
Name:BELL, DAVID BRADFORD (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRADFORD
Last Name:BELL
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 1:102 W MOORE AVE
Mailing Address - Street 2:#218A
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160
Mailing Address - Country:US
Mailing Address - Phone:972-563-1981
Mailing Address - Fax:972-563-1984
Practice Address - Street 1:102 E MOORE AVE
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160
Practice Address - Country:US
Practice Address - Phone:972-563-1981
Practice Address - Fax:972-563-1984
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22362103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00JD68OtherBC/BS
TX034170301Medicaid
TX00JD68OtherBC/BS
TX034170301Medicaid