Healthcare Provider Details

I. General information

NPI: 1407765563
Provider Name (Legal Business Name): BROKEN HALO COUNSELING CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 BALCONES DR STE 100
AUSTIN TX
78731-4298
US

IV. Provider business mailing address

8221 BROKEN ROCK LN
KNOXVILLE TN
37924-4433
US

V. Phone/Fax

Practice location:
  • Phone: 254-489-5708
  • Fax:
Mailing address:
  • Phone: 865-456-9034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BRANDON MATTHEW CANTER
Title or Position: LPC
Credential: LPC
Phone: 865-456-9034