MEDICARE: BEAR CREEK COUNSELING AND TRAUMA RECOVERY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1518724749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAR CREEK COUNSELING AND TRAUMA RECOVERY, LLC

Provider Business Mailing Address
First Line	:	1610 HIGH ST APT 1
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-4731
Country	:	US
Telephone Number	:	904-872-3031
Fax Number	:

Provider Business Practice Location Address
First Line	:	1610 HIGH ST APT 1
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-4731
Country	:	US
Telephone Number	:	904-872-3031
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JEFFREY DANIEL BRAKHAGE
Credential	:	LPC
Telephone Number	:	907-252-8445

Provider Enumeration Date	:	03/04/2024
Last Update Date	:	03/20/2026

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