Individual
BRADLEY FRANK DURHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC1R
Contact information
Practice address
1 SERENITY LN, COBURG, OR 97408-9350
(208) 427-5064
Mailing address
1 SERENITY LN, COBURG, OR 97408-9350
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-23-2661
OR
Other
Enumeration date
06/21/2023
Last updated
06/21/2023
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