Provider Demographics
NPI:1700294550
Name:BETH BRAMBLE PSYCHOTHERAPY ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:BETH BRAMBLE PSYCHOTHERAPY ASSOCIATES, PLLC
Other - Org Name:BRAMBLE COUNSELING & COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL/PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:512-323-2292
Mailing Address - Street 1:4314 MEDICAL PKWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3334
Mailing Address - Country:US
Mailing Address - Phone:512-323-2292
Mailing Address - Fax:866-848-9016
Practice Address - Street 1:4314 MEDICAL PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3334
Practice Address - Country:US
Practice Address - Phone:512-323-2292
Practice Address - Fax:866-848-9016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187383801Medicaid
TX614193OtherMEDICARE PTAN