Provider Demographics
NPI:1750717716
Name:EYLAR, BRADLEY JAMES (CDP)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:JAMES
Last Name:EYLAR
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 E 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1305
Mailing Address - Country:US
Mailing Address - Phone:509-951-9314
Mailing Address - Fax:509-445-0646
Practice Address - Street 1:934 S GARFIELD RD
Practice Address - Street 2:
Practice Address - City:AIRWAY HEIGHTS
Practice Address - State:WA
Practice Address - Zip Code:99001-9030
Practice Address - Country:US
Practice Address - Phone:509-789-7630
Practice Address - Fax:509-445-0646
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60391848101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)