Provider Demographics
NPI:1336222660
Name:BRAGWELL, ALAN D (LPC)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:D
Last Name:BRAGWELL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S SEMINARY ST
Mailing Address - Street 2:STE. 107
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-5665
Mailing Address - Country:US
Mailing Address - Phone:256-332-2234
Mailing Address - Fax:
Practice Address - Street 1:205 S SEMINARY ST
Practice Address - Street 2:KEYSTONE BUSINESS CENTRE
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5665
Practice Address - Country:US
Practice Address - Phone:256-332-2234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL101YM0800X
AL1820101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALBCBS OF ALOther515-14003