Healthcare Provider Details

I. General information

NPI: 1275185852
Provider Name (Legal Business Name): ALEXANDRIA CLAIRE BRANTLEY BRADY LPC-INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14138 HWY 195
KILLEEN TX
76542-4850
US

IV. Provider business mailing address

3398 BOB WHITE LN
BELTON TX
76513-4801
US

V. Phone/Fax

Practice location:
  • Phone: 254-519-1144
  • Fax:
Mailing address:
  • Phone: 478-952-4467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number79168
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: