Provider Information for 1053797126
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PATRICE BRANTLEY LMHC
Sex: Female
NPI: 1053797126
Last Updated: 2019-06-12
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
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| NPI | 1053797126 | ||||||||||||
| Enumeration Date | 2015-07-30 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 4302 GUNN HWY APT 303 TAMPA, FL 33618-8785 United States Phone: 305-450-7655 | Fax: | ||||||||||||
| Primary Practice Address | 6323 MEMORIAL HWY SUITE A TAMPA, FL 33615-4509 United States Phone: 813-891-9474 | Fax: | ||||||||||||
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