Basic Information
| Provider Information | |||||||||
| NPI: | 1245584341 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRACIAK | ||||||||
| FirstName: | JANET | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSED, LPCC-S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3095 KETTERING BLVD | ||||||||
| Address2: | |||||||||
| City: | MORAINE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454391983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372938300 | ||||||||
| FaxNumber: | 9375341347 | ||||||||
| Practice Location | |||||||||
| Address1: | 1349 E STROOP RD | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454294925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372931115 | ||||||||
| FaxNumber: | 9372939455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2012 | ||||||||
| LastUpdateDate: | 10/22/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | E.0007917-SUPV | OH | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | E.0007917-SUPV | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.