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General NPI Number Information
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NPI Number | 1578175253
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Entity Type | Individual
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Provider Name | JEFFREY DANIEL BRAKHAGE LPC
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Gender | Male
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Dates
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Enumeration Date | 08/23/2020
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Last Update Date | 01/22/2021
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Provider Practice Location Address
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Address Line | 35477 KENAI SPUR HWY STE 214
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City | SOLDOTNA
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State | AK
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Zip | 99669-7642
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Country | US
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Telephone | 907-671-6737
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3222
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City | SOLDOTNA
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State | AK
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Zip | 99669-3222
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Country | US
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Telephone | 907-671-6737
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 155471
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 155471
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License Number State | AK
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