Provider Demographics
NPI:1083040927
Name:BRAKO, PHEBE (PHD)
Entity type:Individual
Prefix:DR
First Name:PHEBE
Middle Name:
Last Name:BRAKO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 BRIDGEPORT WAY W STE K
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4724
Mailing Address - Country:US
Mailing Address - Phone:253-778-6636
Mailing Address - Fax:253-343-9008
Practice Address - Street 1:2603 BRIDGEPORT WAY W STE K
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4724
Practice Address - Country:US
Practice Address - Phone:253-778-6636
Practice Address - Fax:253-343-9008
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61482491101YM0800X
WALF60607100106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health