Doctor Name: | FELICIA BRACKETT |
NPI Number: | 1154799179 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | |
Business Practice Address: | 10310 Elizabeth St Unit 2 Westchester, IL - 601543516 |
Business Phone Number: | 7733172056 |
Business Fax Number: | |
Mailing Address: | 10310 Elizabeth St, Unit 2 WESTCHESTER |
State: | IL |
Postal Code: | 601543516 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 09/08/2015 |
NPI Last Update Date: | 09/08/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |