Healthcare Provider Details

I. General information

NPI: 1366351181
Provider Name (Legal Business Name): BRAD VINCENT CLORE CADC1, CRM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61667 SOMERSET DR
BEND OR
97702-8704
US

IV. Provider business mailing address

61667 SOMERSET DR
BEND OR
97702-8704
US

V. Phone/Fax

Practice location:
  • Phone: 541-241-3430
  • Fax:
Mailing address:
  • Phone: 541-241-3430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: