Bryan Brandenburg, MS, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

102717 Issued in AK

Practice address

26731 W Point Mackenzie Rd
Wasilla, AK 99623-8709

Phone

(907) 376-4534

Fax

(907) 376-3248

NPI assigned

Aug 1, 2019

Last updated

Jan 10, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

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.

• Alaska Addiction Rehabilitation Services Inc. Dba Nugen's Ranch

  • Substance Abuse Rehabilitation Facility
  • Wasilla, AK
  • NPI 1417503764
  NPD

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

{
    "created_epoch": "1564617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641772800000",
    "number": "1508411075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1630 N RIVER ROCK CIR",
            "city": "PALMER",
            "state": "AK",
            "postal_code": "996459698",
            "telephone_number": "907-441-7392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26731 W POINT MACKENZIE RD",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996238709",
            "telephone_number": "907-376-4534",
            "fax_number": "907-376-3248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANDENBURG",
        "first_name": "BRYAN",
        "credential": "MS, LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-01",
        "last_updated": "2022-01-10",
        "certification_date": "2022-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "AK",
            "license": "102717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Direct",
            "affiliation": "N",
            "address_1": "26731 W Point MacKenzie Rd",
            "city": "Wasilla",
            "state": "AK",
            "country_code": "US",
            "postal_code": "996238709",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nicolas Bradley, PA-C
• Darian L Bragg
• Mirja Brain
• Sean Eric Braman
• Leah M Bramer, PAC
• Rosanna M Brandon
• Lynn Georgina Branson, LCSW
• Trinity Taylor Brant, CNM
• Colby Michael Braud
• Heather Lynn Bray, CDC II, BHC II

• Professional Counselor in Wasilla, AK
• Providers in Wasilla, AK by specialty
• Professional Counselor in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.