Provider Demographics
NPI:1225661903
Name:PERMENTER, BRIAN KEITH (LPC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:KEITH
Last Name:PERMENTER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5806 BELLA DI GIORNO DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4445
Mailing Address - Country:US
Mailing Address - Phone:972-741-2784
Mailing Address - Fax:
Practice Address - Street 1:2820 SPID DR STE 206
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-1823
Practice Address - Country:US
Practice Address - Phone:361-881-9619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70408101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional