Doctor Name: | BRAD ANDERSON |
NPI Number: | 1255766242 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 21260 N. 1450 E. Moroni, UT - 846460383 |
Business Phone Number: | 4358516821 |
Business Fax Number: | |
Mailing Address: | 21260 N. 1450 E., MORONI |
State: | UT |
Postal Code: | 846460383 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 09/09/2013 |
NPI Last Update Date: | 09/09/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |