Provider Demographics
NPI:1871939769
Name:GLOVER, BRADFORD ROSS (MCJ)
Entity type:Individual
Prefix:MR
First Name:BRADFORD
Middle Name:ROSS
Last Name:GLOVER
Suffix:
Gender:M
Credentials:MCJ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8421 MOONDANCE CELLARS CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-7162
Mailing Address - Country:US
Mailing Address - Phone:702-630-7652
Mailing Address - Fax:
Practice Address - Street 1:8421 MOONDANCE CELLARS CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-7162
Practice Address - Country:US
Practice Address - Phone:702-630-7652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor