Provider Demographics
NPI:1487076493
Name:BRAAKSMA, BENJAMIN (LPCC)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:BRAAKSMA
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 BRITTON FARMS DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-9092
Mailing Address - Country:US
Mailing Address - Phone:206-945-0648
Mailing Address - Fax:206-834-6734
Practice Address - Street 1:4860 BRITTON FARMS DR
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-9092
Practice Address - Country:US
Practice Address - Phone:206-945-0648
Practice Address - Fax:206-834-6734
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60891645101YM0800X
OHE.2303894101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE.2303894OtherLICENSE
WALH60891645OtherLICENSE