Provider Demographics
NPI:1629578133
Name:BOZEMAN, BREE (LPC INTERN)
Entity Type:Individual
Prefix:
First Name:BREE
Middle Name:
Last Name:BOZEMAN
Suffix:
Gender:F
Credentials:LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 GRANGE HALL DR APT 1106
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-1860
Mailing Address - Country:US
Mailing Address - Phone:785-341-8410
Mailing Address - Fax:
Practice Address - Street 1:612 N STORY RD STE 101
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-6764
Practice Address - Country:US
Practice Address - Phone:469-286-6342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78968101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor