Provider Demographics
NPI:1912744798
Name:WESTER, BRAD TIFT
Entity type:Individual
Prefix:MR
First Name:BRAD
Middle Name:TIFT
Last Name:WESTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1947 WESTON AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514-1043
Mailing Address - Country:US
Mailing Address - Phone:803-949-1044
Mailing Address - Fax:
Practice Address - Street 1:5306 YOUNGSTOWN POLAND RD
Practice Address - Street 2:
Practice Address - City:STRUTHERS
Practice Address - State:OH
Practice Address - Zip Code:44471
Practice Address - Country:US
Practice Address - Phone:330-550-6113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH$$$$$$$$$104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker