Provider Demographics
NPI:1245342443
Name:STAGNER, BRIAN H (PHD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:H
Last Name:STAGNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 TARROW ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-7811
Mailing Address - Country:US
Mailing Address - Phone:979-268-1111
Mailing Address - Fax:979-268-5803
Practice Address - Street 1:408 TARROW ST
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-7811
Practice Address - Country:US
Practice Address - Phone:979-268-1111
Practice Address - Fax:979-268-5803
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-2768103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical