Provider Demographics
NPI:1194938167
Name:BRAKINS CONSULTING & PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:BRAKINS CONSULTING & PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAVADA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:GARRETT-AKINSANYA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:612-302-3140
Mailing Address - Street 1:13805 60TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-3583
Mailing Address - Country:US
Mailing Address - Phone:612-839-1449
Mailing Address - Fax:763-550-9398
Practice Address - Street 1:2100 PLYMOUTH AVE N
Practice Address - Street 2:SUITE #245
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-3675
Practice Address - Country:US
Practice Address - Phone:612-302-3140
Practice Address - Fax:612-436-5412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4105103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN990991046885OtherPREFERRED ONE
MNHP29938OtherHEALTHPARTNERS
MN239323900Medicaid
MN1033294962OtherPERSON NPI #
MN42653GAOtherGROUP- BCBS
MN113550OtherUCARE (BHP)
MN6168492OtherUNITED BEHAVIORAL HEALTH