Provider Demographics
NPI:1518724749
Name:BEAR CREEK COUNSELING AND TRAUMA RECOVERY, LLC
Entity Type:Organization
Organization Name:BEAR CREEK COUNSELING AND TRAUMA RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BRAKHAGE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:907-252-8445
Mailing Address - Street 1:44539 STERLING HWY STE 209
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7960
Mailing Address - Country:US
Mailing Address - Phone:904-872-3031
Mailing Address - Fax:
Practice Address - Street 1:44539 STERLING HWY STE 209
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7960
Practice Address - Country:US
Practice Address - Phone:904-872-3031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)