Provider Demographics
NPI:1497399844
Name:CRAIG, BRIANNA (LMFT-A)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 SUNRIDGE DR APT 609
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-7331
Mailing Address - Country:US
Mailing Address - Phone:402-570-2123
Mailing Address - Fax:
Practice Address - Street 1:6609 MANCHACA RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-4934
Practice Address - Country:US
Practice Address - Phone:512-222-7955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203536106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty