Provider Demographics
NPI:1730904814
Name:BRANDON, KIYOMI LABRISKA
Entity type:Individual
Prefix:
First Name:KIYOMI
Middle Name:LABRISKA
Last Name:BRANDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 CLINTON AVE W APT A
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-3056
Mailing Address - Country:US
Mailing Address - Phone:256-414-5282
Mailing Address - Fax:
Practice Address - Street 1:2219 CLINTON AVE W APT A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-3056
Practice Address - Country:US
Practice Address - Phone:256-414-5282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician