Provider Demographics
NPI:1518177856
Name:BRACKINS & ASSOCIATES
Entity Type:Organization
Organization Name:BRACKINS & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:BRACKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, SAP
Authorized Official - Phone:281-272-1115
Mailing Address - Street 1:525 N SAM HOUSTON PKWY E
Mailing Address - Street 2:SUITE 597
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-4037
Mailing Address - Country:US
Mailing Address - Phone:281-272-1115
Mailing Address - Fax:281-272-1117
Practice Address - Street 1:525 N SAM HOUSTON PKWY E
Practice Address - Street 2:SUITE 597
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-4037
Practice Address - Country:US
Practice Address - Phone:281-272-1115
Practice Address - Fax:281-272-1117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10580101YA0400X
TX117951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142403801Medicaid
TX00069SMedicare ID - Type UnspecifiedGROUP
TXUR58841Medicare UPIN