Provider Demographics
NPI:1790461093
Name:CERDA, BRANDI DIANE
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:DIANE
Last Name:CERDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3086 COUNTY ROAD 3860
Mailing Address - Street 2:
Mailing Address - City:HAWKINS
Mailing Address - State:TX
Mailing Address - Zip Code:75765-5397
Mailing Address - Country:US
Mailing Address - Phone:972-806-2439
Mailing Address - Fax:
Practice Address - Street 1:406 W BLAIR ST
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:TX
Practice Address - Zip Code:75773-1607
Practice Address - Country:US
Practice Address - Phone:903-638-0071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91683101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional