Provider Demographics
NPI:1992437065
Name:DEGROAT, BRANDIE CHRISTINE (LPC)
Entity type:Individual
Prefix:
First Name:BRANDIE
Middle Name:CHRISTINE
Last Name:DEGROAT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 17TH AVE S STE 11
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-4781
Mailing Address - Country:US
Mailing Address - Phone:208-249-0432
Mailing Address - Fax:
Practice Address - Street 1:824 17TH AVE S STE 11
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-4781
Practice Address - Country:US
Practice Address - Phone:208-249-0432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health