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General NPI Number Information
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NPI Number | 1114780574
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Entity Type | Individual
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Provider Name | BRIAN J. BRADFORD LPC
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Gender | Male
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Dates
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Enumeration Date | 01/30/2024
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Last Update Date | 02/01/2024
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Provider Practice Location Address
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Address Line | 300 CENTURY PARK S STE 100
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City | BIRMINGHAM
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State | AL
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Zip | 35226-3924
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Country | US
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Telephone | 205-547-2721
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Fax |
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Provider Business Mailing Address
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Address Line | 235 CAMBRIAN RIDGE TRL
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City | PELHAM
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State | AL
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Zip | 35124-4822
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Country | US
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Telephone | 205-567-1201
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC05048
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License Number State | AL
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