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NPI Code Detail

MEDICARE: BRANDI HERZOG ATR, LPC-S

MEDICARE: BRANDI HERZOG ATR, LPC-S
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
1101YA0400XAddiction (Substance Use Disorder) Counselor13294TX
2101YM0800XMental Health Counselor74921TX
3221700000XArt Therapist74921TX
4101YP2500XProfessional Counselor74921TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
117-104OTHERATCB CERTIFICATION

General Provider Information

NPI Number : 1376052787
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDI HERZOG ATR, LPC-S
Provider Business Mailing Address
First Line : 1735 KELLER SPRINGS RD STE 202
Second Line :
City : CARROLLTON
State : TX
Zip : 75006-3006
Country : US
Telephone Number : 844-824-8775
Fax Number :
Provider Business Practice Location Address
First Line : 1735 KELLER SPRINGS RD STE 202
Second Line :
City : CARROLLTON
State : TX
Zip : 75006-3006
Country : US
Telephone Number : 844-824-8775
Fax Number : 281-648-2200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2017
Last Update Date : 02/06/2025

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