Provider Demographics
NPI:1710796032
Name:SIMONS, BRADLEY EDWARD I (RTB)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:EDWARD
Last Name:SIMONS
Suffix:I
Gender:M
Credentials:RTB
Other - Prefix:MR
Other - First Name:BRADLEY
Other - Middle Name:EDWARD
Other - Last Name:SIMONS
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:N/A
Mailing Address - Street 1:1630 CRATER CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-3030
Mailing Address - Country:US
Mailing Address - Phone:775-391-9226
Mailing Address - Fax:
Practice Address - Street 1:561 KEYSTONE AVE # 324
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4304
Practice Address - Country:US
Practice Address - Phone:185-583-2672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-01
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician