Provider Demographics
NPI:1558731125
Name:BROTZMAN, BRIAN (MA, TLMHC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:BROTZMAN
Suffix:
Gender:M
Credentials:MA, TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1967 S RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1058
Mailing Address - Country:US
Mailing Address - Phone:563-581-7979
Mailing Address - Fax:
Practice Address - Street 1:2515 18TH ST SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-3303
Practice Address - Country:US
Practice Address - Phone:563-581-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA073380101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health