Provider Demographics
NPI:1306224605
Name:BONNIE LEE BRAGLIA LPC-S,LMFT,CCDVC
Entity Type:Organization
Organization Name:BONNIE LEE BRAGLIA LPC-S,LMFT,CCDVC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST,SUPERVISOR LPC TX,
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BRAGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:BSN,LPC-S,LMFT,CCDVC
Authorized Official - Phone:361-774-0293
Mailing Address - Street 1:3434 ALAMEDA ST.
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411
Mailing Address - Country:US
Mailing Address - Phone:361-774-0293
Mailing Address - Fax:361-452-0029
Practice Address - Street 1:4659 EVERHART RD. SUITE 109
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411
Practice Address - Country:US
Practice Address - Phone:361-774-0293
Practice Address - Fax:361-452-0029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2914251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX106HOOOOOXOtherMARRIAGE & FAMILY THERAPIST
TX103TF0200XOtherCLINICALLY CERTIFIED DOMESTIC VIOLENCE COUNSELOR, F17949
TXF17949OtherFORENSIC COUNSELOR CLINICALLY CERTIFIED DOMESTIC VIOLENCE COUNSELOR
101YP2500XOtherLICENSED PROFESSIONAL COUNSELOR-SUPERVISOR-STATE OF TEXAS
TX101YP2500XOtherLICENSED PROFESSIONAL COUNSELOR-SUPERVISOR-STATE OF TEXAS
TX106HOOOOOXOtherLICENSED MARRIAGE & FAMILY THERAPIST, LICENSED PROFESSIONAL COUNSELOR-SUPERVISOR
TXF17949OtherFORENSIC COUNSELOR CLINICALLY CERTIFIED DOMESTIC VIOLENCE COUNSELOR