Provider Demographics
NPI:1922350131
Name:BRANDT, LINDA KAY (101YP2500X)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:KAY
Last Name:BRANDT
Suffix:
Gender:F
Credentials:101YP2500X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 GRANBURY ST
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-5752
Mailing Address - Country:US
Mailing Address - Phone:817-558-3203
Mailing Address - Fax:817-558-7566
Practice Address - Street 1:1011 GRANBURY ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-5752
Practice Address - Country:US
Practice Address - Phone:817-558-3203
Practice Address - Fax:817-558-7566
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66845101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional