Provider Demographics
NPI:1427381235
Name:SANFORD, BRYAN DARVELL (JD)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:DARVELL
Last Name:SANFORD
Suffix:
Gender:M
Credentials:JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12567 W MAZATZAL DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-0380
Mailing Address - Country:US
Mailing Address - Phone:702-578-6779
Mailing Address - Fax:
Practice Address - Street 1:12567 W MAZATZAL DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-0380
Practice Address - Country:US
Practice Address - Phone:702-578-6779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty