Provider Demographics
NPI:1467630186
Name:MCNAUGHT, JOHN BRADLEY
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:BRADLEY
Last Name:MCNAUGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BRAD
Other - Middle Name:
Other - Last Name:MCNAUGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MDIV, CEAP, SAP
Mailing Address - Street 1:1660 HIGHWAY 100 S
Mailing Address - Street 2:SUITE 430
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1529
Mailing Address - Country:US
Mailing Address - Phone:952-222-4967
Mailing Address - Fax:
Practice Address - Street 1:1660 HIGHWAY 100 S
Practice Address - Street 2:SUITE 430
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-1529
Practice Address - Country:US
Practice Address - Phone:952-222-4967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral