Provider Demographics
NPI:1740852623
Name:ERIN BRAAKSMA, LCSW, PLLC
Entity type:Organization
Organization Name:ERIN BRAAKSMA, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAAKSMA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-920-0948
Mailing Address - Street 1:322 PINE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-8628
Mailing Address - Country:US
Mailing Address - Phone:406-581-2794
Mailing Address - Fax:
Practice Address - Street 1:1227 N 14TH AVE STE 3
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3282
Practice Address - Country:US
Practice Address - Phone:406-920-0948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty