Provider Demographics
NPI:1386358638
Name:BRAND, KENNETH DANE (LSAT)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:DANE
Last Name:BRAND
Suffix:
Gender:M
Credentials:LSAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 N ARIZONA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-7166
Mailing Address - Country:US
Mailing Address - Phone:480-360-3339
Mailing Address - Fax:
Practice Address - Street 1:3140 N ARIZONA AVE STE 101
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-7166
Practice Address - Country:US
Practice Address - Phone:480-360-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLSAT-15125101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)