Provider Demographics
NPI:1831104363
Name:BRAZAS, ADAM (PHD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:BRAZAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1776
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-1776
Mailing Address - Country:US
Mailing Address - Phone:870-425-6901
Mailing Address - Fax:870-424-8703
Practice Address - Street 1:8 MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2919
Practice Address - Country:US
Practice Address - Phone:870-425-6901
Practice Address - Fax:870-424-8703
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP9008114103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
56587OtherMEDICARE