Provider Demographics
NPI:1720822349
Name:BRAZEAU, LYNDA LEE (CERTIFIED CADC)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:LEE
Last Name:BRAZEAU
Suffix:
Gender:F
Credentials:CERTIFIED CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1611
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544-1611
Mailing Address - Country:US
Mailing Address - Phone:208-476-4440
Mailing Address - Fax:208-476-4441
Practice Address - Street 1:PO BOX 1611
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-1611
Practice Address - Country:US
Practice Address - Phone:208-476-4440
Practice Address - Fax:208-476-4441
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID11752101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)