Provider Demographics
NPI:1518667393
Name:ENGELKING, BRANDON ARTHUR (PSS)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:ARTHUR
Last Name:ENGELKING
Suffix:
Gender:M
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12837 N 113TH AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:YOUNGTOWN
Mailing Address - State:AZ
Mailing Address - Zip Code:85363-1063
Mailing Address - Country:US
Mailing Address - Phone:520-474-0814
Mailing Address - Fax:
Practice Address - Street 1:3345 W PORTLAND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-3408
Practice Address - Country:US
Practice Address - Phone:520-474-0814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)