Provider Demographics
NPI:1477877447
Name:BREWER, CAROLYN
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 RAWHIDE DR
Mailing Address - Street 2:SUITE 318
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-6957
Mailing Address - Country:US
Mailing Address - Phone:512-388-3638
Mailing Address - Fax:512-388-3634
Practice Address - Street 1:1970 RAWHIDE DR
Practice Address - Street 2:SUITE 318
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-6957
Practice Address - Country:US
Practice Address - Phone:512-388-3638
Practice Address - Fax:512-388-3634
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-20
Last Update Date:2010-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65481101Y00000X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional