Healthcare Provider Details

I. General information

NPI: 1205446630
Provider Name (Legal Business Name): EMILY ANN BREWER PHD, LP, LSSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 BRIARCREST DR
BRYAN TX
77802-2529
US

IV. Provider business mailing address

1100 BRIARCREST DR
BRYAN TX
77802-2529
US

V. Phone/Fax

Practice location:
  • Phone: 979-229-7636
  • Fax:
Mailing address:
  • Phone: 979-229-7636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number71324
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number38652
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: