Provider Demographics
NPI:1205331402
Name:URBAN, BRANDI LEE (MED, LPC)
Entity type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:LEE
Last Name:URBAN
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 LCR 762
Mailing Address - Street 2:
Mailing Address - City:GROESBECK
Mailing Address - State:TX
Mailing Address - Zip Code:76642-2149
Mailing Address - Country:US
Mailing Address - Phone:254-315-1657
Mailing Address - Fax:
Practice Address - Street 1:204 N PARIS ST
Practice Address - Street 2:
Practice Address - City:MEXIA
Practice Address - State:TX
Practice Address - Zip Code:76667-2843
Practice Address - Country:US
Practice Address - Phone:254-307-1748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74110101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional