Provider Demographics
NPI:1922102383
Name:MCLARNON, BRADFORD RUSSELL (MS EDS NCC LMIT LMHC)
Entity Type:Individual
Prefix:MR
First Name:BRADFORD
Middle Name:RUSSELL
Last Name:MCLARNON
Suffix:
Gender:M
Credentials:MS EDS NCC LMIT LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 N AUDUBON RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219
Mailing Address - Country:US
Mailing Address - Phone:317-353-1930
Mailing Address - Fax:
Practice Address - Street 1:6308B RUCKER RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220
Practice Address - Country:US
Practice Address - Phone:317-713-1208
Practice Address - Fax:317-465-9689
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
24794E101YA0400X
IN39000288A101YM0800X
IN35001081A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist