Healthcare Provider Details

I. General information

NPI: 1447799895
Provider Name (Legal Business Name): SUSAN BRAMEL LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E PIKE ST
CYNTHIANA KY
41031-1681
US

IV. Provider business mailing address

2099 KY HIGHWAY 982
CYNTHIANA KY
41031-9629
US

V. Phone/Fax

Practice location:
  • Phone: 859-569-3145
  • Fax:
Mailing address:
  • Phone: 859-221-3537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1242
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: