Provider Demographics
NPI:1629490735
Name:BRACEFUL, ANTHONY SR
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:BRACEFUL
Suffix:SR
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 1:113 CALVERT ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NV
Mailing Address - Zip Code:89403-9787
Mailing Address - Country:US
Mailing Address - Phone:775-434-4829
Mailing Address - Fax:
Practice Address - Street 1:113 CALVERT ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NV
Practice Address - Zip Code:89403-9787
Practice Address - Country:US
Practice Address - Phone:775-434-4829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health