Provider Demographics
NPI:1235429986
Name:DEVAR, BRAD (MA, MED, CAGS)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:DEVAR
Suffix:
Gender:M
Credentials:MA, MED, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39315 N CORTONA DR
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-6242
Mailing Address - Country:US
Mailing Address - Phone:480-882-3500
Mailing Address - Fax:
Practice Address - Street 1:39315 N CORTONA DR
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-6242
Practice Address - Country:US
Practice Address - Phone:480-882-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12222103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool