Individual
EVAN TODD BRACKENBURY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8811 S TACOMA WAY STE 204&206, TACOMA, WA 98499-4595
(425) 217-1140
Mailing address
11114 W ARICA RD, CASA GRANDE, AZ 85193-9033
(520) 634-8601
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
03/07/2024
Last updated
08/19/2024
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