Healthcare Provider Details

I. General information

NPI: 1417877200
Provider Name (Legal Business Name): BRANDON TRCA LPC, LAMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8152 N WAYNE DR
HAYDEN ID
83835-6065
US

IV. Provider business mailing address

2688 W DUMONT DR
COEUR D ALENE ID
83815-5069
US

V. Phone/Fax

Practice location:
  • Phone: 208-691-4687
  • Fax:
Mailing address:
  • Phone: 949-751-8370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number6571792
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3581601
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3581601
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3581601
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: