MEDICARE: MR. JEFFREY DANIEL BRAKHAGE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	155471	AK
2	101YM0800X	Mental Health Counselor	155471	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578175253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY DANIEL BRAKHAGE LPC

Provider Business Mailing Address
First Line	:	1610 HIGH ST APT 1
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-4731
Country	:	US
Telephone Number	:	907-252-8445
Fax Number	:

Provider Business Practice Location Address
First Line	:	1610 HIGH ST APT 1
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-4731
Country	:	US
Telephone Number	:	907-252-8445
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2020
Last Update Date	:	03/20/2026

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