Provider Demographics
NPI:1558941286
Name:BRACKS FAMILY COUNSELING
Entity type:Organization
Organization Name:BRACKS FAMILY COUNSELING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:BRACK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:314-626-0962
Mailing Address - Street 1:10805 SUNSET OFFICE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1026
Mailing Address - Country:US
Mailing Address - Phone:402-975-5650
Mailing Address - Fax:
Practice Address - Street 1:10805 SUNSET OFFICE DR STE 201
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1026
Practice Address - Country:US
Practice Address - Phone:402-975-5650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-08
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)