Provider Demographics
NPI:1427556018
Name:BONSALL, BRAND
Entity Type:Individual
Prefix:MR
First Name:BRAND
Middle Name:
Last Name:BONSALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 SANTA CLARA DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:UT
Mailing Address - Zip Code:84765
Mailing Address - Country:US
Mailing Address - Phone:435-674-9310
Mailing Address - Fax:
Practice Address - Street 1:2711 SANTA CLARA DRIVE
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:UT
Practice Address - Zip Code:84765
Practice Address - Country:US
Practice Address - Phone:435-674-9310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional