Provider Demographics
NPI:1609272061
Name:BRAZEL, MISTY EILEEN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:EILEEN
Last Name:BRAZEL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 S SPRIGG ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-6212
Mailing Address - Country:US
Mailing Address - Phone:573-651-4177
Mailing Address - Fax:
Practice Address - Street 1:20 S SPRIGG ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-6212
Practice Address - Country:US
Practice Address - Phone:573-651-4177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002009574101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health