Provider Demographics
NPI:1508037748
Name:BROTHERS, GARY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:
Last Name:BROTHERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 MANCHACA RD
Mailing Address - Street 2:STE 306
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-5374
Mailing Address - Country:US
Mailing Address - Phone:808-628-8960
Mailing Address - Fax:
Practice Address - Street 1:8700 MANCHACA RD
Practice Address - Street 2:STE 306
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5374
Practice Address - Country:US
Practice Address - Phone:808-628-8960
Practice Address - Fax:512-292-1144
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-16
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX502021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical