Healthcare Provider Details

I. General information

NPI: 1144585464
Provider Name (Legal Business Name): BRAD A. KOLANO M.A., LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 SILHAVY RD STE 100
VALPARAISO IN
46383-4461
US

IV. Provider business mailing address

505 SILHAVY RD STE 100
VALPARAISO IN
46383-4461
US

V. Phone/Fax

Practice location:
  • Phone: 219-464-1234
  • Fax:
Mailing address:
  • Phone: 219-464-1234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101006591
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35002036A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101007426
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: