Goben, Bradley Carlyle

Goben, Bradley Carlyle is an individual health care provider with primary practice located at 313 N Mattis Ave , Champaign IL 61821-2460. He recently has only one registered license in Behavioral Health & Social Service Providers / Professional, which is considered as his primary health care specialty. Goben, Bradley Carlyle can be contacted via phone (217) 348-1086.

Contact Information

Primary practice address
313 N Mattis Ave Champaign IL 61821-2460
Phone: (217) 348-1086
Fax: (217) 355-4012
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Professional 101YP2500X Illinois

Profile Details

NPI number 1073645578
LBN Legal business name Goben, Bradley Carlyle
Credentials MA LCPC
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 10th, 2007
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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