Provider Demographics
NPI:1245584341
Name:BRACIAK, JANET M (MSED, LPCC-S)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:M
Last Name:BRACIAK
Suffix:
Gender:F
Credentials:MSED, LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3095 KETTERING BLVD
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1983
Mailing Address - Country:US
Mailing Address - Phone:937-293-8300
Mailing Address - Fax:937-534-1347
Practice Address - Street 1:1349 E STROOP RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-4925
Practice Address - Country:US
Practice Address - Phone:937-293-1115
Practice Address - Fax:937-293-9455
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0007917-SUPV101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor