Healthcare Provider Details

I. General information

NPI: 1679760276
Provider Name (Legal Business Name): JOAN M BRACKMANN M.A., L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3672 B ARSENAL ST.
ST. LOUIS MO
63116-4821
US

IV. Provider business mailing address

3672 B ARSENAL ST.
ST. LOUIS MO
63116-4821
US

V. Phone/Fax

Practice location:
  • Phone: 314-664-9766
  • Fax: 314-246-9646
Mailing address:
  • Phone: 314-664-9766
  • Fax: 314-246-9646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2000150928
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: