Healthcare Provider Details

I. General information

NPI: 1487738241
Provider Name (Legal Business Name): BRADLEY J. HUFFORD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 SHORE DR REHABILITATION HOSPITAL OF INDIANA
INDIANAPOLIS IN
46254-2607
US

IV. Provider business mailing address

855 BENNETT RD
CARMEL IN
46032-5252
US

V. Phone/Fax

Practice location:
  • Phone: 317-329-2448
  • Fax:
Mailing address:
  • Phone: 317-441-2309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20041694A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number20041694A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: