Provider Demographics
NPI:1801789482
Name:STAHNKE, BRANDON DONALD (BA, CAP)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:DONALD
Last Name:STAHNKE
Suffix:
Gender:M
Credentials:BA, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1981 W WOOLBRIGHT RD APT E202
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-6335
Mailing Address - Country:US
Mailing Address - Phone:561-312-1559
Mailing Address - Fax:
Practice Address - Street 1:1981 W WOOLBRIGHT RD APT E202
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-6335
Practice Address - Country:US
Practice Address - Phone:561-312-1559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0100610101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)