1659925055 NPI number — MR. BRADFORD GREGORY PARFITT LCSW, CDCII, BHAIII

Table of content: MR. BRADFORD GREGORY PARFITT LCSW, CDCII, BHAIII (NPI 1659925055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659925055 NPI number — MR. BRADFORD GREGORY PARFITT LCSW, CDCII, BHAIII

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARFITT
Provider First Name:
BRADFORD
Provider Middle Name:
GREGORY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, CDCII, BHAIII
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:
1659925055
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 CHANNEL DR STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JUNEAU
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99801-7837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-463-4000
Provider Business Mailing Address Fax Number:
907-463-4075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3051 VITAGE BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JUNEAU
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-463-0160
Provider Business Practice Location Address Fax Number:
907-463-0161
Provider Enumeration Date:
07/25/2019

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: 101YA0400X , with the licence number:  4063 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 210716 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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