Provider Demographics
NPI:1821392861
Name:BRAZIE, CRYSTINA L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CRYSTINA
Middle Name:L
Last Name:BRAZIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1744 E MCANDREWS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504
Mailing Address - Country:US
Mailing Address - Phone:541-776-0821
Mailing Address - Fax:541-776-5011
Practice Address - Street 1:1744 E MCANDREWS RD
Practice Address - Street 2:SUITE B
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-776-0821
Practice Address - Fax:541-776-5011
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
ORL56731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor