MEDICARE: BRADFORD POE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1831618305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADFORD POE

Provider Business Mailing Address
First Line	:	PO BOX 390
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25708-0390
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 W MADISON ST STE B
Second Line	:
City	:	LOUISA
State	:	KY
Zip	:	41230-1327
Country	:	US
Telephone Number	:	606-826-0341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2017
Last Update Date	:	09/15/2017

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Directions to “ BRADFORD POE ” Practice Location

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