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General NPI Number Information
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NPI Number | 1134471535
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Entity Type | Organization
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Legal Business Name | BROCKMAN COUNSELING LLC
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Dates
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Enumeration Date | 10/09/2012
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 5301 VILLAGE CREEK DR STE B
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City | PLANO
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State | TX
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Zip | 75093-4838
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Country | US
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Telephone | 972-372-9644
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Fax |
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Provider Business Mailing Address
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Address Line | 5301 VILLAGE CREEK DR STE B
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City | PLANO
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State | TX
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Zip | 75093-4838
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Country | US
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Telephone | 972-372-9644
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. BENJAMIN PATRICK BROCKMAN
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Credential |
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Telephone | 972-372-9644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 65542
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License Number State | TX
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