Individual
KAITLIN BRAZIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, PCMSW, PLMHP
Contact information
Practice address
2201 N BROADWELL AVE, GRAND ISLAND, NE 68803-2153
(308) 382-3660
Mailing address
2201 N BROADWELL AVE, GRAND ISLAND, NE 68803-2153
(308) 382-3660
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11747
STATE LICENSE
NE
01
—
7331
STATE LICENSE
NE
Enumeration date
01/30/2019
Last updated
05/20/2021
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