Provider Demographics
NPI:1093067076
Name:BRADY, CINDY L (BHPP)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:L
Last Name:BRADY
Suffix:
Gender:F
Credentials:BHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 N SULPHUR SPRINGS RD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85607
Mailing Address - Country:US
Mailing Address - Phone:520-780-4188
Mailing Address - Fax:
Practice Address - Street 1:500 E NASHVILLE 994 SOUTH HARRISON RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:86748
Practice Address - Country:US
Practice Address - Phone:520-780-4188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4177839171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4177839OtherTHERAPEUTIC FOSTER CARE LICENSE