Provider Demographics
NPI:1942417829
Name:COHN, BRADLEY PHILLIP (PHD)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:PHILLIP
Last Name:COHN
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 1:911 COUNTRY CLUB RD STE 290
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-1301
Mailing Address - Country:US
Mailing Address - Phone:541-313-6199
Mailing Address - Fax:541-576-8977
Practice Address - Street 1:911 COUNTRY CLUB RD STE 290
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-1301
Practice Address - Country:US
Practice Address - Phone:541-313-6199
Practice Address - Fax:541-576-8977
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TS0200X, 101YM0800X
OR2867103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500662798Medicaid