Evan Todd Brackenbury

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

8811 S Tacoma Way Ste 204&206
Tacoma, WA 98499-4595

Phone

(425) 217-1140

NPI assigned

Mar 7, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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

• Kitsap Mental Health Services

  • Community/Behavioral Health Agency
  • Bremerton, WA
  • NPI 1033268008
  NPD (past)

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

{
    "created_epoch": "1709769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724025600000",
    "number": "1982462750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11114 W ARICA RD",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851939033",
            "telephone_number": "520-634-8601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8811 S TACOMA WAY STE 204&206",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984994595",
            "telephone_number": "425-217-1140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRACKENBURY",
        "first_name": "EVAN",
        "middle_name": "TODD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-03-07",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alison Bozic
• Nicole Daisy Bozlee, NREMT
• Teresa Ann Braasch, CNA
• Anna Brabbins, MS, OTR/L
• Jennifer Bracken, DNP, FNP-C
• Greta Cullen Brackman, CG60872398
• Janet Lee Braden
• Justin Bradfield
• Richard M Bradford, MD
• Bradley County Dialysis

• Counselor in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; 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.