MEDICARE: BRAZOS VALLEY PSYCHOLOGICAL SERVICES PA

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
1	103T00000X	Psychologist	32759	TX

General Provider Information

NPI Number	:	1154357747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAZOS VALLEY PSYCHOLOGICAL SERVICES PA

Provider Business Mailing Address
First Line	:	704 E 29TH ST STE B
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77803-4898
Country	:	US
Telephone Number	:	979-574-8801
Fax Number	:	855-265-1950

Provider Business Practice Location Address
First Line	:	704B E 29TH ST
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77803-4706
Country	:	US
Telephone Number	:	979-574-8801
Fax Number	:	979-775-9079

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KIM MARIE ARREDONDO
Credential	:	PH.D.
Telephone Number	:	979-574-8801

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	05/12/2025

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