Provider Demographics
NPI:1003386988
Name:ROBERTS, BRANDON MICHAEL (MED, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:MICHAEL
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 DALLAS ST
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-2908
Mailing Address - Country:US
Mailing Address - Phone:409-234-5777
Mailing Address - Fax:877-250-4835
Practice Address - Street 1:1219 DALLAS ST
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-2908
Practice Address - Country:US
Practice Address - Phone:409-234-5777
Practice Address - Fax:877-250-4835
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77674101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty