Provider Demographics
NPI:1063015444
Name:PACKARD, BRYANT H (LMFTA)
Entity Type:Individual
Prefix:
First Name:BRYANT
Middle Name:H
Last Name:PACKARD
Suffix:
Gender:M
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9432 KATY FWY STE 460
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6349
Mailing Address - Country:US
Mailing Address - Phone:512-853-0334
Mailing Address - Fax:
Practice Address - Street 1:9432 KATY FWY STE 460
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6349
Practice Address - Country:US
Practice Address - Phone:815-010-1092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist