Healthcare Provider Details

I. General information

NPI: 1639084726
Provider Name (Legal Business Name): BRANDY GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 ROCK CHALK DR UNIT 2101
LAWRENCE KS
66049-5215
US

IV. Provider business mailing address

5800 ROCK CHALK DR UNIT 2101
LAWRENCE KS
66049-5215
US

V. Phone/Fax

Practice location:
  • Phone: 620-309-1934
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3231591317
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: