Provider Demographics
NPI:1891820189
Name:ANDERSON, BRENT (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14918 CHETLAND PLACE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-2988
Mailing Address - Country:US
Mailing Address - Phone:281-856-7609
Mailing Address - Fax:
Practice Address - Street 1:5638 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6325
Practice Address - Country:US
Practice Address - Phone:281-392-7505
Practice Address - Fax:281-392-7644
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17730101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional