Provider Demographics
NPI:1952724973
Name:BRASCH, REBECCA ANN (LMHC LIC#14135)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANN
Last Name:BRASCH
Suffix:
Gender:F
Credentials:LMHC LIC#14135
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3768 HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:MC DAVID
Mailing Address - State:FL
Mailing Address - Zip Code:32568-2010
Mailing Address - Country:US
Mailing Address - Phone:850-698-2890
Mailing Address - Fax:850-361-2089
Practice Address - Street 1:3768 HOWELL RD
Practice Address - Street 2:
Practice Address - City:MC DAVID
Practice Address - State:FL
Practice Address - Zip Code:32568-2010
Practice Address - Country:US
Practice Address - Phone:850-698-2890
Practice Address - Fax:850-361-2089
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14135101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health