Angel Brazeal
Individual provider Active NPI Social Worker · Pleasanton, KS
NPI 1710724166 · NPPES record last updated Jul 12, 2024
Key facts
- NPI
- 1710724166
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- License
- 13655 (KS)
- Practice address
- 505 W 15TH St
Pleasanton, KS 66075-4095 - Phone
- (913) 352-8214
- NPI assigned
- Jul 12, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13655 | KS | MD | Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeast Kansas Mental Health Center | Past | Accepting new patients | |
| Southeast Kansas Mental Health Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 13655 | KS | Yes |
Addresses
Primary practice location
505 W 15TH St
Pleasanton, KS 66075-4095
Mailing address
304 N Jefferson Ave
Iola, KS 66749-2327
Other providers in Pleasanton, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 12, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.