Provider Demographics
NPI:1740679026
Name:NUGENT, BRANT (LPC)
Entity type:Individual
Prefix:MR
First Name:BRANT
Middle Name:
Last Name:NUGENT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 IMPERIAL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-4225
Mailing Address - Country:US
Mailing Address - Phone:361-445-4080
Mailing Address - Fax:888-413-3010
Practice Address - Street 1:1700 WILDCAT DR
Practice Address - Street 2:SUITE D
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-2817
Practice Address - Country:US
Practice Address - Phone:361-445-4080
Practice Address - Fax:888-413-3010
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68839101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor