Provider Demographics
NPI:1326335431
Name:POWELL, BRANDY (MA, LPC, RPT)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:MA, LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 NORTH LOOP WEST
Mailing Address - Street 2:4TH FLOOR, SUITE 101
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-0101
Mailing Address - Country:US
Mailing Address - Phone:936-697-6898
Mailing Address - Fax:
Practice Address - Street 1:1110 N LOOP 336 W
Practice Address - Street 2:4TH FLOOR, SUITE 101
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1193
Practice Address - Country:US
Practice Address - Phone:936-539-6771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-09
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64879101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health