Provider Demographics
NPI:1699001255
Name:BRATT, ETHAN LINNELL (MS, LMFT, CST)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:LINNELL
Last Name:BRATT
Suffix:
Gender:M
Credentials:MS, LMFT, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 102ND AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-9058
Mailing Address - Country:US
Mailing Address - Phone:970-599-1820
Mailing Address - Fax:
Practice Address - Street 1:1711 61ST AVE STE 206
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3049
Practice Address - Country:US
Practice Address - Phone:970-599-1820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001102106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist