Provider Demographics
NPI:1861926784
Name:BACHMAN, BRANDIE JENNELL (BEHAVIOR ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:BRANDIE
Middle Name:JENNELL
Last Name:BACHMAN
Suffix:
Gender:F
Credentials:BEHAVIOR ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 DOUBLE BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32567-2842
Mailing Address - Country:US
Mailing Address - Phone:850-902-9696
Mailing Address - Fax:
Practice Address - Street 1:3960 ARBOR TRACE DR UNIT B
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-6723
Practice Address - Country:US
Practice Address - Phone:850-902-9696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician