Provider Demographics
NPI:1851613798
Name:BRACEY, LINDA RYAN (CDP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:RYAN
Last Name:BRACEY
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8210 N LUCIA CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-9676
Mailing Address - Country:US
Mailing Address - Phone:509-868-9566
Mailing Address - Fax:509-747-3485
Practice Address - Street 1:2910 N MONROE ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-3359
Practice Address - Country:US
Practice Address - Phone:509-868-9566
Practice Address - Fax:509-747-3485
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00026606101Y00000X
WACP00003922101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)