Provider Demographics
NPI:1790034973
Name:BRABHAM, JODY LEE (CAS II)
Entity Type:Individual
Prefix:MRS
First Name:JODY
Middle Name:LEE
Last Name:BRABHAM
Suffix:
Gender:F
Credentials:CAS II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 ORO DAM BLVD
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966
Mailing Address - Country:US
Mailing Address - Phone:530-533-5272
Mailing Address - Fax:530-533-5821
Practice Address - Street 1:2740 ORO DAM BLVD E
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-5117
Practice Address - Country:US
Practice Address - Phone:530-533-5272
Practice Address - Fax:530-533-5821
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA03-108260171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator