Individual
JACOB BRADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMHC-A
Contact information
Practice address
323 E 2ND ST, MARION, IN 46952-3871
(765) 573-5567
(765) 741-0359
Mailing address
240 N TILLOTSON AVE, MUNCIE, IN 47304-3988
(765) 288-1928
(765) 741-0335
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
99111834A
IN
Other
Enumeration date
12/02/2021
Last updated
06/07/2022
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