Provider Demographics
NPI:1528386133
Name:BRASWELL, PEGGY J (MS, LPC)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:J
Last Name:BRASWELL
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3833 S STAPLES ST # 203
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5201
Mailing Address - Country:US
Mailing Address - Phone:361-852-9665
Mailing Address - Fax:361-852-2794
Practice Address - Street 1:3833 S STAPLES ST # 203
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5201
Practice Address - Country:US
Practice Address - Phone:361-852-9665
Practice Address - Fax:361-852-2794
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64267101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health