Provider Demographics
NPI:1548591522
Name:BRACEWELL, JATU A (MFT)
Entity Type:Individual
Prefix:
First Name:JATU
Middle Name:A
Last Name:BRACEWELL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8931 N NEW RIVER CANAL RD
Mailing Address - Street 2:3F
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3831
Mailing Address - Country:US
Mailing Address - Phone:954-681-5750
Mailing Address - Fax:
Practice Address - Street 1:8931 N NEW RIVER CANAL RD
Practice Address - Street 2:3F
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3831
Practice Address - Country:US
Practice Address - Phone:954-681-5750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist