Provider Demographics
NPI:1346786100
Name:BRAZOS RESIDENTIAL TREATMENT CENTER, LLC
Entity Type:Organization
Organization Name:BRAZOS RESIDENTIAL TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEFCIK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCSW, LCDC
Authorized Official - Phone:254-232-1550
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:MORGAN
Mailing Address - State:TX
Mailing Address - Zip Code:76671-0092
Mailing Address - Country:US
Mailing Address - Phone:254-232-1550
Mailing Address - Fax:254-775-4040
Practice Address - Street 1:257 FM 927
Practice Address - Street 2:
Practice Address - City:MORGAN
Practice Address - State:TX
Practice Address - Zip Code:76671
Practice Address - Country:US
Practice Address - Phone:254-232-1550
Practice Address - Fax:254-775-4040
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRAZOS RECOVERY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility