Provider Demographics
NPI:1265053268
Name:UNRUH, BRADLEY (MFT, LPC, LMFTA)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:UNRUH
Suffix:
Gender:M
Credentials:MFT, LPC, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 OLD HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-3608
Mailing Address - Country:US
Mailing Address - Phone:330-807-6420
Mailing Address - Fax:
Practice Address - Street 1:1290 OLD HENDERSON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-3608
Practice Address - Country:US
Practice Address - Phone:330-807-6420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801061101YP2500X
IN85000346A106H00000X
OHM.1800064106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional