Healthcare Provider Details

I. General information

NPI: 1407779150
Provider Name (Legal Business Name): TERRAN BRANTLEY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 LEAGUE LINE RD APT 3107
CONROE TX
77304-3499
US

IV. Provider business mailing address

1575 LEAGUE LINE RD APT 3107
CONROE TX
77304-3499
US

V. Phone/Fax

Practice location:
  • Phone: 318-436-8927
  • Fax:
Mailing address:
  • Phone: 318-436-8927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number118039
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: