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General NPI Number Information
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NPI Number | 1063874683
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Entity Type | Organization
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Legal Business Name | BRAZOS VALLEY MENTAL HEALTH AND WELLNESS, LLC
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Dates
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Enumeration Date | 03/23/2016
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 1600 S DAY ST
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City | BRENHAM
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State | TX
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Zip | 77833-4828
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Country | US
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Telephone | 979-777-1683
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Fax |
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Provider Business Mailing Address
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Address Line | 600 WALNUT HILL DR
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City | BRENHAM
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State | TX
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Zip | 77833-4986
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Country | US
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Telephone | 979-777-1683
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. SHERRY HAFERKAMP
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Credential | PSY.D.
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Telephone | 979-777-1683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 37193
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License Number State | TX
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