Jaclyn Renee Braziel, QMHP

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

C4153 Issued in OR

Practice address

182 SW Academy St
Dallas, OR 97338-1996

Phone

(503) 623-9289

NPI assigned

May 28, 2009

Last updated

Feb 21, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jaclyn Renee Branske Former name

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Hope for Change Counseling

  • Mental Health Counselor
  • Dallas, OR
  • NPI 1942944079
  NPD Authorized official
• Coordinated Counseling for Children

  dba Victoria Wisdom-Imbach

  • Professional Counselor
  • Salem, OR
  • NPI 1295251437
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1243468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582243200000",
    "number": "1194950576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2205 S CHURCH ST",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973389742",
            "telephone_number": "503-930-7349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "182 SW ACADEMY ST",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973381996",
            "telephone_number": "503-623-9289"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "528 Cottage St NE",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973013811",
            "country_code": "US",
            "telephone_number": "503-450-9900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRAZIEL",
        "first_name": "JACLYN",
        "middle_name": "RENEE",
        "name_prefix": "Ms.",
        "credential": "QMHP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-28",
        "last_updated": "2020-02-21",
        "certification_date": "2020-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "C4153",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "BRANSKE",
            "middle_name": "RENEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Danielle Bosse, LMT
• Jade M Bostwick
• Tiffany Bouchard, MS, NCC
• Lisa Brady
• Sarah K Brattain, PHARMD
• Dustin Breitwieser, M.A.
• Natalie Ann Brick, DMD
• Adam Christopher Brown, BA
• Ashley E Brown, LMFT
• Elizabeth Rosario Brown

• Mental Health Counselor in Dallas, OR
• Providers in Dallas, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.