Healthcare Provider Details

I. General information

NPI: 1952724973
Provider Name (Legal Business Name): REBECCA ANN BRASCH LMHC LIC#14135
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3768 HOWELL RD
MC DAVID FL
32568-2010
US

IV. Provider business mailing address

3768 HOWELL RD
MC DAVID FL
32568-2010
US

V. Phone/Fax

Practice location:
  • Phone: 850-698-2890
  • Fax: 850-361-2089
Mailing address:
  • Phone: 850-698-2890
  • Fax: 850-361-2089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14135
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: