Provider Demographics
NPI:1558019588
Name:STUCKI, BRADFORD (PHD, LMFT)
Entity type:Individual
Prefix:
First Name:BRADFORD
Middle Name:
Last Name:STUCKI
Suffix:
Gender:
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 N UNIVERSITY AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3857
Mailing Address - Country:US
Mailing Address - Phone:801-477-6823
Mailing Address - Fax:
Practice Address - Street 1:2520 N UNIVERSITY AVE STE 202
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3857
Practice Address - Country:US
Practice Address - Phone:801-477-6823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001902106H00000X
UT12737565-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist