Provider Demographics
NPI:1881869691
Name:BEALL, BRENDA (LMSW, LCDC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:BEALL
Suffix:
Gender:F
Credentials:LMSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6037 ARBOR BND APT 913
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-2921
Mailing Address - Country:US
Mailing Address - Phone:972-697-7338
Mailing Address - Fax:
Practice Address - Street 1:7535 OAKMONT BLVD STE 101
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4237
Practice Address - Country:US
Practice Address - Phone:800-972-0643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39034104100000X
TX15887101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker