Provider Demographics
NPI:1285315911
Name:YACKEE, BRANDI
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:YACKEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6241 ZEHMAN CT
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-1430
Mailing Address - Country:US
Mailing Address - Phone:216-672-8673
Mailing Address - Fax:
Practice Address - Street 1:437 LAFAYETTE RD STE 200
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2398
Practice Address - Country:US
Practice Address - Phone:216-672-8673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801492101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional