Provider Demographics
NPI:1275185852
Name:BRADY, ALEXANDRIA CLAIRE BRANTLEY (LPC-INTERN)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:CLAIRE BRANTLEY
Last Name:BRADY
Suffix:
Gender:F
Credentials:LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3398 BOB WHITE LN
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-4801
Mailing Address - Country:US
Mailing Address - Phone:478-952-4467
Mailing Address - Fax:
Practice Address - Street 1:14138 HWY 195
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-4850
Practice Address - Country:US
Practice Address - Phone:254-519-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79168101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health