Provider Demographics
NPI:1982751822
Name:BRUSHER, EDWARD ALLEN (LCSW)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:ALLEN
Last Name:BRUSHER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 PHANTOM CRK
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-4277
Mailing Address - Country:US
Mailing Address - Phone:210-375-4869
Mailing Address - Fax:210-221-7235
Practice Address - Street 1:USA MEDCOM
Practice Address - Street 2:2050 WORTH ROAD, SUITE 10
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-6010
Practice Address - Country:US
Practice Address - Phone:210-221-8235
Practice Address - Fax:210-221-7235
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA23641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical