Basic Information
| Provider Information | |||||||||
| NPI: | 1720702699 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRANDT | ||||||||
| FirstName: | JAMI | ||||||||
| MiddleName: | ALISE | ||||||||
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| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HELLAND | ||||||||
| OtherFirstName: | JAMI | ||||||||
| OtherMiddleName: | ALISE | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 17691 E STATE ROUTE 106 | ||||||||
| Address2: | |||||||||
| City: | BELFAIR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985288514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535763472 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3560 BRIDGEPORT WAY W STE 2C | ||||||||
| Address2: | |||||||||
| City: | UNIVERSITY PLACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984664446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534607248 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2022 | ||||||||
| LastUpdateDate: | 10/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | MG61344560 | WA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 106H00000X | MG61344560 | WA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.