Healthcare Provider Details

I. General information

NPI: 1093573495
Provider Name (Legal Business Name): CLAIRE ELIZABETH BAGGETT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CLAIRE ELIZABETH BRANTLEY

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/11/2024
Certification Date: 03/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5522 LONE STAR PKWY STE 303
SAN ANTONIO TX
78253-6722
US

IV. Provider business mailing address

148 RIFLE GAP
UNIVERSAL CITY TX
78148-3628
US

V. Phone/Fax

Practice location:
  • Phone: 210-664-1275
  • Fax:
Mailing address:
  • Phone: 210-608-9340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number85360
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: