Active NPI
Jody Lyn Brand, LPC, NCC
- Mental Health Counselor
- Bethel, AK
National Provider Identifier
1992007702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 6903328-6004
- Practice address
- 1410 Calista Drive
Bethel, AK 99559-0528 - Phone
- (907) 543-6730
- Fax
- (907) 543-6712
- NPI assigned
- Nov 30, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 6903328-6004 | UT | Primary |
Addresses
Primary practice location
1410 Calista Drive
Bethel, AK 99559-0528
Mailing address
410 North 100 East
P.O. Box 440219
Koosharem, UT 84744-0219
Phone (435) 638-7373
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1020986 | Medicaid | AK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6903328-6004 | UT | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sorensons Ranch School | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Psychiatric Residential Treatment Facility
- Koosharem, UT
- NPI 1013991256
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1291075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568764800000",
"number": "1992007702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "410 NORTH 100 EAST",
"address_2": "P.O. BOX 440219",
"city": "KOOSHAREM",
"state": "UT",
"postal_code": "847440219",
"telephone_number": "435-638-7373",
"fax_number": "435-638-1105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1410 CALISTA DRIVE",
"city": "BETHEL",
"state": "AK",
"postal_code": "995590528",
"telephone_number": "907-543-6730",
"fax_number": "907-543-6712"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAND",
"first_name": "JODY",
"middle_name": "LYN",
"name_prefix": "Mrs.",
"credential": "LPC, NCC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-11-30",
"last_updated": "2019-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "UT",
"license": "6903328-6004",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1020986",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bethel, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.