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General NPI Number Information
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NPI Number | 1396166245
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Entity Type | Individual
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Provider Name | GREGORY BRIGANDO LPC
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Gender | Male
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Dates
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Enumeration Date | 12/19/2013
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Last Update Date | 12/19/2013
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Provider Practice Location Address
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Address Line | 804 S TEXAS AVE
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City | BRYAN
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State | TX
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Zip | 77803-3946
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Country | US
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Telephone | 979-361-9815
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Fax |
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Provider Business Mailing Address
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Address Line | 1504 S TEXAS AVE
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City | BRYAN
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State | TX
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Zip | 77802-1015
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Country | US
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Telephone |
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Fax | 979-822-6467
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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 | 70961
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License Number State | TX
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