Provider Demographics
NPI:1518747575
Name:BRAZLE, LARA (LLMFT)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:BRAZLE
Suffix:
Gender:F
Credentials:LLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2253 SOMERSET RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0668
Mailing Address - Country:US
Mailing Address - Phone:248-421-2376
Mailing Address - Fax:
Practice Address - Street 1:2253 SOMERSET RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0668
Practice Address - Country:US
Practice Address - Phone:248-421-2376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4151001119106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist