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General NPI Number Information
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NPI Number | 1376801993
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Entity Type | Individual
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Provider Name | SANDRA BRAVO LPC INTERN
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Gender | Female
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Dates
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Enumeration Date | 05/02/2012
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Last Update Date | 05/02/2012
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Provider Practice Location Address
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Address Line | 100 E CENTRAL TEXAS EXPY STE 100
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City | KILLEEN
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State | TX
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Zip | 76541-8509
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Country | US
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Telephone | 254-501-3555
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Fax | 254-501-3554
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Provider Business Mailing Address
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Address Line | 4226 LAKECLIFF DR
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City | HARKER HEIGHTS
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State | TX
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Zip | 76548-8611
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Country | US
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Telephone | 254-537-3123
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 69167
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License Number State | TX
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