Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1043224900 |
---|---|
Provider Name | Mr. Tedd M Bradford |
First Address | Sellersville, PA 18960-1549 |
Second Address | Sellersville, PA 18960-1549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 08/07/2007 |