Brad Todd Mattingly, MA, LISAC, CDVC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

LISAC1135 Issued in AZ

Practice address

1750 S Woodlands Village Blvd Ste 135
Flagstaff, AZ 86001-2699

Phone

(602) 685-6000

Fax

(928) 679-2181

NPI assigned

Sep 14, 2012

Last updated

Nov 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699315200000",
    "number": "1386994564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3003 N CENTRAL AVE STE 400",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122929",
            "telephone_number": "602-685-6000",
            "fax_number": "928-679-2199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 S WOODLANDS VILLAGE BLVD STE 135",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860012699",
            "telephone_number": "602-685-6000",
            "fax_number": "928-679-2181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTINGLY",
        "first_name": "BRAD",
        "middle_name": "TODD",
        "name_prefix": "Mr.",
        "credential": "MA, LISAC, CDVC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-09-14",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "AZ",
            "license": "LISAC1135",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Wallace Mathewson, M.D.
• Amanda Frances Matje, PA-C
• Amanda Mattei, AU.D.
• Cynthia Mattern, M.A.
• Eris Matthews
• Emily Ann Mauer, PHARMD
• Amanda Lynn Maurer, PPD CLC
• Robert Eugene Maurer, D.D.S.
• Vincent Keith Maurer, PT
• Elizabeth Cecilia Mawhinney

• Addiction (Substance Use Disorder) Counselor in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• Addiction (Substance Use Disorder) Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.