Provider Demographics
NPI:1225144454
Name:BRANDT, BARBARA JEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:JEAN
Last Name:BRANDT
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 1:4221 APPALOOSA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9121
Mailing Address - Country:US
Mailing Address - Phone:915-867-5483
Mailing Address - Fax:915-564-7867
Practice Address - Street 1:600 SUNLAND PARK DR
Practice Address - Street 2:BLDG 6, SUITE 400
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5115
Practice Address - Country:US
Practice Address - Phone:915-867-5483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26861103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0066CTOtherBLUE CROSS BLUE SHIELD
TX00353EMedicare ID - Type UnspecifiedMEDICARE PROVIDER #