Provider Demographics
NPI:1821815036
Name:BRANTLEY, JUSTIN KYLE (LPC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:KYLE
Last Name:BRANTLEY
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 1:20236 JOVE OAK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-4407
Mailing Address - Country:US
Mailing Address - Phone:210-862-3734
Mailing Address - Fax:
Practice Address - Street 1:2939 W WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-5015
Practice Address - Country:US
Practice Address - Phone:210-212-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89386101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health