Provider Demographics
NPI:1124253190
Name:BRADFORD, KAY (PHD)
Entity type:Individual
Prefix:DR
First Name:KAY
Middle Name:
Last Name:BRADFORD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 E 500 N
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4228
Mailing Address - Country:US
Mailing Address - Phone:435-232-0381
Mailing Address - Fax:435-213-3800
Practice Address - Street 1:670 E 500 N
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4228
Practice Address - Country:US
Practice Address - Phone:435-232-0381
Practice Address - Fax:435-213-3800
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3672733902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist