Healthcare Provider Details

I. General information

NPI: 1518846351
Provider Name (Legal Business Name): ZACHARY J BRAZELL LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ZACH JORDAN BRAZELL LPC

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 ARLINGTON AVE
CALDWELL ID
83605-4808
US

IV. Provider business mailing address

PO BOX 9
NAMPA ID
83653-0009
US

V. Phone/Fax

Practice location:
  • Phone: 208-323-9600
  • Fax: 208-466-5359
Mailing address:
  • Phone: 208-467-4431
  • Fax: 208-466-5359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3081336
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: