Healthcare Provider Details

I. General information

NPI: 1285315911
Provider Name (Legal Business Name): BRANDI YACKEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 LAFAYETTE RD STE 200
MEDINA OH
44256-2398
US

IV. Provider business mailing address

6241 ZEHMAN CT
BROOKPARK OH
44142-1430
US

V. Phone/Fax

Practice location:
  • Phone: 216-672-8673
  • Fax:
Mailing address:
  • Phone: 216-672-8673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.1801492
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: