Provider Demographics
NPI:1942069067
Name:BRACEY, JERONE
Entity Type:Individual
Prefix:MR
First Name:JERONE
Middle Name:
Last Name:BRACEY
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 1:712 WILCREST DR # 2111
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-1348
Mailing Address - Country:US
Mailing Address - Phone:346-529-7822
Mailing Address - Fax:
Practice Address - Street 1:12410 WEST LITTLE YORK #124
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041
Practice Address - Country:US
Practice Address - Phone:346-529-7822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health