Provider Demographics
NPI:1679016877
Name:CHATFIELD, BRANDON (LAC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:CHATFIELD
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 N 56TH ST BLDG B
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-8718
Mailing Address - Country:US
Mailing Address - Phone:602-541-4599
Mailing Address - Fax:888-974-1094
Practice Address - Street 1:152 N 56TH ST BLDG B
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-8718
Practice Address - Country:US
Practice Address - Phone:602-541-4599
Practice Address - Fax:888-974-1094
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-16002101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor