NPI Code Detail JSON Logo

1386994564 NPI number — BRAD TODD MATTINGLY MA, LISAC, CDVC

NPI Number: 1386994564
Health Care Provider/Practitioner: BRAD TODD MATTINGLY MA, LISAC, CDVC

Information about “1386994564” NPI (BRAD TODD MATTINGLY MA, LISAC, CDVC) exists in 1386994564 in HTML format HTML  |  1386994564 in plain Text format TXT  |  1386994564 in PDF (Portable Document Format) PDF  |  1386994564 in an XML format XML  formats.

NPI Number : 1386994564 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1386994564",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MATTINGLY",
    "FirstName": "BRAD",
    "MiddleName": "TODD",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "MA, LISAC, CDVC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3003 N CENTRAL AVE STE 400",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PHOENIX",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85012-2929",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "602-685-6000",
    "MailingAddressFaxNumber": "928-679-2199",
    "FirstLinePracticeLocationAddress": "1750 S WOODLANDS VILLAGE BLVD STE 135",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FLAGSTAFF",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "86001-2699",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "602-685-6000",
    "PracticeLocationAddressFaxNumber": "928-679-2181",
    "EnumerationDate": "09/14/2012",
    "LastUpdateDate": "11/07/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YA0400X",
        "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
        "LicenseNumber": "LISAC1135",
        "LicenseNumberStateCode": "AZ",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.