Provider Demographics
NPI:1811386394
Name:ANTHONY BRATKO
Entity Type:Organization
Organization Name:ANTHONY BRATKO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BRATKO
Authorized Official - Suffix:
Authorized Official - Credentials:MSC, LPC, LISAC
Authorized Official - Phone:602-402-4474
Mailing Address - Street 1:1117 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-5304
Mailing Address - Country:US
Mailing Address - Phone:602-402-4474
Mailing Address - Fax:
Practice Address - Street 1:1117 W 9TH ST
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5304
Practice Address - Country:US
Practice Address - Phone:602-402-4474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-14567261QM0850X
AZLISAC-11892261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health