Provider Demographics
NPI:1780137489
Name:BRANTLEY-DANIELS, BETH ANNE
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANNE
Last Name:BRANTLEY-DANIELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S COPPER KEY CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-7425
Mailing Address - Country:US
Mailing Address - Phone:602-405-7501
Mailing Address - Fax:
Practice Address - Street 1:801 S COPPER KEY CT
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-7425
Practice Address - Country:US
Practice Address - Phone:602-405-7501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2355733171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator