Healthcare Provider Details

I. General information

NPI: 1275148694
Provider Name (Legal Business Name): BRAD THAYER LPC, NCC, CCTP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 BISBEE RD
BISBEE AZ
85603-1140
US

IV. Provider business mailing address

7 BISBEE RD
BISBEE AZ
85603-1140
US

V. Phone/Fax

Practice location:
  • Phone: 520-432-2042
  • Fax:
Mailing address:
  • Phone: 520-432-2042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-20916
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: