Provider Demographics
NPI:1255085973
Name:CALLIHAN, BRADIE LYN (RBT)
Entity type:Individual
Prefix:
First Name:BRADIE
Middle Name:LYN
Last Name:CALLIHAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16425 STATE ROUTE 7
Mailing Address - Street 2:
Mailing Address - City:GREENUP
Mailing Address - State:KY
Mailing Address - Zip Code:41144-6990
Mailing Address - Country:US
Mailing Address - Phone:740-357-8665
Mailing Address - Fax:
Practice Address - Street 1:1112 GALLIA ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4161
Practice Address - Country:US
Practice Address - Phone:740-981-3176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRBT-20-141308106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician