Provider Demographics
NPI:1881963007
Name:OHS, BRADLEY GENE (LCSW)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:GENE
Last Name:OHS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-0446
Mailing Address - Country:US
Mailing Address - Phone:907-745-7799
Mailing Address - Fax:907-745-7799
Practice Address - Street 1:349 E COTTONWOOD AVE
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6404
Practice Address - Country:US
Practice Address - Phone:907-745-7799
Practice Address - Fax:907-745-7799
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKLCSW 5621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical