Provider Demographics
NPI:1720702699
Name:BRANDT, JAMI ALISE
Entity Type:Individual
Prefix:
First Name:JAMI
Middle Name:ALISE
Last Name:BRANDT
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JAMI
Other - Middle Name:ALISE
Other - Last Name:HELLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:17691 E STATE ROUTE 106
Mailing Address - Street 2:
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-8514
Mailing Address - Country:US
Mailing Address - Phone:253-576-3472
Mailing Address - Fax:
Practice Address - Street 1:3560 BRIDGEPORT WAY W STE 2C
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4446
Practice Address - Country:US
Practice Address - Phone:253-460-7248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG61344560101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional