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General NPI Number Information
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NPI Number | 1306224605
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Entity Type | Organization
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Legal Business Name | BONNIE LEE BRAGLIA LPC-S,LMFT,CCDVC
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Dates
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Enumeration Date | 05/07/2015
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Last Update Date | 05/07/2015
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Provider Practice Location Address
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Address Line | 4659 EVERHART RD. SUITE 109
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City | CORPUS CHRISTI
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State | TX
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Zip | 78411
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Country | US
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Telephone | 361-774-0293
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Fax | 361-452-0029
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Provider Business Mailing Address
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Address Line | 3434 ALAMEDA ST.
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City | CORPUS CHRISTI
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State | TX
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Zip | 78411
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Country | US
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Telephone | 361-774-0293
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Fax | 361-452-0029
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Authorized Official
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Title or Position | PSYCHOTHERAPIST,SUPERVISOR LPC TX,
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Name | MS. BONNIE LEE BRAGLIA
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Credential | BSN,LPC-S,LMFT,CCDVC
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Telephone | 361-774-0293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2914
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License Number State | TX
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