Provider Demographics
NPI:1396448973
Name:POLLEY, BRANDON
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:POLLEY
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 1:9416 W ATLANTIS WAY
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-5740
Mailing Address - Country:US
Mailing Address - Phone:602-329-8248
Mailing Address - Fax:
Practice Address - Street 1:14804 N CAVE CREEK RD STE 104
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4945
Practice Address - Country:US
Practice Address - Phone:501-613-8117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician