Provider Demographics
NPI:1609093707
Name:CPRC HOLDING LLC
Entity Type:Organization
Organization Name:CPRC HOLDING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRICKEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:281-364-0067
Mailing Address - Street 1:25134 OAKHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-1421
Mailing Address - Country:US
Mailing Address - Phone:281-630-3721
Mailing Address - Fax:
Practice Address - Street 1:25134 OAKHURST DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-1421
Practice Address - Country:US
Practice Address - Phone:281-630-3721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60602101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty