Provider Demographics
NPI:1972895969
Name:JERRED, BRANDON MITCHELL (MA, MFT)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:MITCHELL
Last Name:JERRED
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-4899
Mailing Address - Country:US
Mailing Address - Phone:515-432-7983
Mailing Address - Fax:515-432-7657
Practice Address - Street 1:105 S MARSHALL ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-4899
Practice Address - Country:US
Practice Address - Phone:515-432-7983
Practice Address - Fax:515-432-7657
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000327106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist