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General NPI Number Information
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NPI Number | 1992007702
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Entity Type | Individual
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Provider Name | JODY LYN BRAND LPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 11/30/2010
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Last Update Date | 09/18/2019
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Provider Practice Location Address
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Address Line | 1410 CALISTA DRIVE
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City | BETHEL
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State | AK
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Zip | 99559-0528
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Country | US
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Telephone | 907-543-6730
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Fax | 907-543-6712
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Provider Business Mailing Address
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Address Line | 410 NORTH 100 EAST P.O. BOX 440219
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City | KOOSHAREM
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State | UT
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Zip | 84744-0219
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Country | US
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Telephone | 435-638-7373
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Fax | 435-638-1105
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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 | 6903328-6004
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License Number State | UT
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