Provider Demographics
NPI:1982142568
Name:BRAZOS PROFESSIONAL COUNSELING PLLC
Entity Type:Organization
Organization Name:BRAZOS PROFESSIONAL COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-221-0299
Mailing Address - Street 1:1220 N BRAZOS ST STE 4A
Mailing Address - Street 2:
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692-2050
Mailing Address - Country:US
Mailing Address - Phone:254-221-0299
Mailing Address - Fax:
Practice Address - Street 1:1220 N BRAZOS ST STE 4A
Practice Address - Street 2:
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692-2050
Practice Address - Country:US
Practice Address - Phone:254-221-0299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty