1154658854 NPI number — MR. BRADLEY TODD KINDER LPC, CSAC

Table of content: MR. BRADLEY TODD KINDER LPC, CSAC (NPI 1154658854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154658854 NPI number — MR. BRADLEY TODD KINDER LPC, CSAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KINDER
Provider First Name:
BRADLEY
Provider Middle Name:
TODD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LPC, CSAC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154658854
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 426
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR BLUFF
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24609-0426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-963-0111
Provider Business Mailing Address Fax Number:
276-963-0005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 CEDAR VALLEY DRIVE
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
CEDAR BLUFF
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-963-0111
Provider Business Practice Location Address Fax Number:
276-963-0005
Provider Enumeration Date:
11/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0701004720 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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