Provider Demographics
NPI:1750052015
Name:BRASKETT, RICHARD PAUL
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:PAUL
Last Name:BRASKETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 NW IVY CIR
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-9357
Mailing Address - Country:US
Mailing Address - Phone:360-931-0544
Mailing Address - Fax:
Practice Address - Street 1:3121 NW IVY CIR
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-9357
Practice Address - Country:US
Practice Address - Phone:360-931-0544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-25
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health