Provider Demographics
NPI:1053528125
Name:HOUGHTON, BRAD WILLIAM (PSYD, LP)
Entity type:Individual
Prefix:MR
First Name:BRAD
Middle Name:WILLIAM
Last Name:HOUGHTON
Suffix:
Gender:M
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5019 38TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-1662
Mailing Address - Country:US
Mailing Address - Phone:612-308-7038
Mailing Address - Fax:
Practice Address - Street 1:5019 38TH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-1662
Practice Address - Country:US
Practice Address - Phone:612-308-7038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4812103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent