Healthcare Provider Details

I. General information

NPI: 1336952837
Provider Name (Legal Business Name): DOUGLAS KENNETH BRAASE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8225 FL-54
TRINITY FL
34655
US

IV. Provider business mailing address

3723 ROUND TABLE CT
LAND O LAKES FL
34638-2003
US

V. Phone/Fax

Practice location:
  • Phone: 813-575-0570
  • Fax:
Mailing address:
  • Phone: 813-767-5553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: