Provider Demographics
NPI:1730792490
Name:BRACKETT'S THERAPUTIC COUNSELING SERVICE
Entity type:Organization
Organization Name:BRACKETT'S THERAPUTIC COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRACKETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:810-250-3749
Mailing Address - Street 1:PO BOX 3462
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-0462
Mailing Address - Country:US
Mailing Address - Phone:810-422-5585
Mailing Address - Fax:810-422-5583
Practice Address - Street 1:3922 LARCHMONT ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5270
Practice Address - Country:US
Practice Address - Phone:810-250-3749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty