Healthcare Provider Details

I. General information

NPI: 1437143344
Provider Name (Legal Business Name): JOHN MARSHALL BRAGG LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 SGT ED HOLCOMB BLVD S
CONROE TX
77304-1990
US

IV. Provider business mailing address

233 SGT ED HOLCOMB BLVD S
CONROE TX
77304-1990
US

V. Phone/Fax

Practice location:
  • Phone: 936-521-6446
  • Fax:
Mailing address:
  • Phone: 936-521-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number15938
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: