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NPI Code Detail

MEDICARE: BRANDON MICHAEL ROBERTS M.ED., NCC, LPC

MEDICARE:   BRANDON MICHAEL ROBERTS  M.ED., NCC, LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor77674TX

General Provider Information

NPI Number : 1003386988
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDON MICHAEL ROBERTS M.ED., NCC, LPC
Provider Business Mailing Address
First Line : 1219 DALLAS ST
Second Line :
City : PORT NECHES
State : TX
Zip : 77651-2908
Country : US
Telephone Number : 409-234-5777
Fax Number : 877-250-4835
Provider Business Practice Location Address
First Line : 1219 DALLAS ST
Second Line :
City : PORT NECHES
State : TX
Zip : 77651-2908
Country : US
Telephone Number : 409-234-5777
Fax Number : 877-250-4835
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2018
Last Update Date : 02/24/2022

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Directions to “ BRANDON MICHAEL ROBERTS M.ED., NCC, LPC” Practice Location

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