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Individual
MR. BRAD TODD MATTINGLY
Active
Individual
MR. BRAD TODD MATTINGLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LISAC, CDVC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC1135
AZ
Other
Enumeration date
09/14/2012
Last updated
11/07/2023
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