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General NPI Number Information
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NPI Number | 1194938167
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Entity Type | Organization
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Legal Business Name | BRAKINS CONSULTING & PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 09/24/2015
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Provider Practice Location Address
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Address Line | 2100 PLYMOUTH AVE N SUITE #245
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City | MINNEAPOLIS
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State | MN
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Zip | 55411-3675
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Country | US
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Telephone | 612-302-3140
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Fax | 612-436-5412
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Provider Business Mailing Address
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Address Line | 13805 60TH AVE N
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City | PLYMOUTH
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State | MN
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Zip | 55446-3583
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Country | US
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Telephone | 612-839-1449
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Fax | 763-550-9398
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. BRAVADA MAE GARRETT-AKINSANYA
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Credential | PH.D.
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Telephone | 612-302-3140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP4105
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License Number State | MN
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