Provider Demographics
NPI:1467271692
Name:DRAGONFLY BEHAVIORAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:DRAGONFLY BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C, CAQ-PSY
Authorized Official - Phone:575-386-6585
Mailing Address - Street 1:1 11TH AVE STE A2
Mailing Address - Street 2:
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-1318
Mailing Address - Country:US
Mailing Address - Phone:575-386-6585
Mailing Address - Fax:
Practice Address - Street 1:1 11TH AVE STE A2
Practice Address - Street 2:
Practice Address - City:SHALIMAR
Practice Address - State:FL
Practice Address - Zip Code:32579-1318
Practice Address - Country:US
Practice Address - Phone:850-790-9621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty