Provider Demographics
NPI:1619339595
Name:SNELL, BRADLY DEE
Entity Type:Individual
Prefix:MR
First Name:BRADLY
Middle Name:DEE
Last Name:SNELL
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 1:2350 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3018
Mailing Address - Country:US
Mailing Address - Phone:707-565-4963
Mailing Address - Fax:707-565-3409
Practice Address - Street 1:2350 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3018
Practice Address - Country:US
Practice Address - Phone:707-565-4963
Practice Address - Fax:707-565-3409
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health