Provider Demographics
NPI:1376002832
Name:VIPOND, BRADLEY DAVID (PLMHP)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:DAVID
Last Name:VIPOND
Suffix:
Gender:M
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14188 MOTHER THERESA LN
Mailing Address - Street 2:
Mailing Address - City:BOYS TOWN
Mailing Address - State:NE
Mailing Address - Zip Code:68010-7554
Mailing Address - Country:US
Mailing Address - Phone:402-498-3025
Mailing Address - Fax:402-964-7150
Practice Address - Street 1:14188 MOTHER THERESA LN
Practice Address - Street 2:
Practice Address - City:BOYS TOWN
Practice Address - State:NE
Practice Address - Zip Code:68010-7554
Practice Address - Country:US
Practice Address - Phone:402-498-3025
Practice Address - Fax:402-964-7150
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11790101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor