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General NPI Number Information
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NPI Number | 1154357747
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Entity Type | Organization
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Legal Business Name | BRAZOS VALLEY PSYCHOLOGICAL SERVICES PA
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 704B E 29TH ST
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City | BRYAN
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State | TX
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Zip | 77803-4706
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Country | US
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Telephone | 979-574-8801
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Fax | 979-775-9079
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Provider Business Mailing Address
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Address Line | 704 E 29TH ST STE B
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City | BRYAN
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State | TX
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Zip | 77803-4898
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Country | US
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Telephone | 979-574-8801
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Fax | 855-265-1950
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KIM MARIE ARREDONDO
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Credential | PH.D.
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Telephone | 979-574-8801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 32759
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License Number State | TX
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