Provider Demographics
NPI:1336338821
Name:BRANNON, DESTIN N (LPC)
Entity Type:Individual
Prefix:
First Name:DESTIN
Middle Name:N
Last Name:BRANNON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 MAGNOLIA PKWY
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-2455
Mailing Address - Country:US
Mailing Address - Phone:214-789-3384
Mailing Address - Fax:
Practice Address - Street 1:521 MAGNOLIA PKWY
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76126-2455
Practice Address - Country:US
Practice Address - Phone:214-789-3384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84559101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171720902Medicaid
TX8T5468OtherBCBS