Provider Demographics
NPI:1831882141
Name:PRATT, SATCHEL HANNIBAL (MS)
Entity type:Individual
Prefix:MR
First Name:SATCHEL
Middle Name:HANNIBAL
Last Name:PRATT
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:ANDREW
Other - Last Name:BRUCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1309 E 1ST PL
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-8921
Mailing Address - Country:US
Mailing Address - Phone:310-876-9512
Mailing Address - Fax:
Practice Address - Street 1:12631 E 17TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2527
Practice Address - Country:US
Practice Address - Phone:303-724-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician