=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255407516
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT BRAMMER PH.D., LPC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6900 W INTERSTATE 40 STE 190A
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79106-2525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-676-2539
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 350 MEADOW VIEW DR
-----------------------------------------------------
City | ELLENSBURG
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98926-8211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-963-3629
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 14622
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------