Provider Demographics
NPI:1376172718
Name:BRASHEAR, STEVEN ROGER
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ROGER
Last Name:BRASHEAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 OLOLU DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2857
Mailing Address - Country:US
Mailing Address - Phone:407-534-2163
Mailing Address - Fax:
Practice Address - Street 1:441 OLOLU DR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2857
Practice Address - Country:US
Practice Address - Phone:407-534-2163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19109101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty