Healthcare Provider Details

I. General information

NPI: 1861321408
Provider Name (Legal Business Name): BRADFORD RESTORATIVE BEHAVIORAL INNOVATIONS CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7325 MEDICAL CENTER DR
WEST HILLS CA
91307-1925
US

IV. Provider business mailing address

37312 LIANA LN
PALMDALE CA
93551-6239
US

V. Phone/Fax

Practice location:
  • Phone: 586-360-9700
  • Fax: 248-747-9325
Mailing address:
  • Phone: 586-360-9700
  • Fax: 248-747-9325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TERRENCE TERRENCE BRADFORD
Title or Position: OWNER
Credential: PMHNP
Phone: 586-244-3208