Doctor Name: | DR. JOHN ROSS BRADLEY |
NPI Number: | 1033243837 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | 168 |
Business Practice Address: | 100 Cheyenne Ave. Lame Deer, MT - 590430070 |
Business Phone Number: | 4064774514 |
Business Fax Number: | 4064774513 |
Mailing Address: | Po Box 1894, COLSTRIP |
State: | MT |
Postal Code: | 593231894 |
Phone Number: | 4064774514 |
Fax Number: | 4064774513 |
NPI Enumeration Date: | 03/15/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 168 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |