Provider Demographics
NPI:1528679230
Name:BRADY, BARBARA B
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:B
Last Name:BRADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 RIDGEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-1366
Mailing Address - Country:US
Mailing Address - Phone:304-633-6833
Mailing Address - Fax:
Practice Address - Street 1:4035 RIDGEVIEW LN
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-1366
Practice Address - Country:US
Practice Address - Phone:304-633-6833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-14
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV219101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV219OtherLICENSED PROFESSIONAL COUNSELOR