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General NPI Number Information
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NPI Number | 1598134363
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Entity Type | Individual
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Provider Name | DANA BRODE MSW/MHP
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Gender | Female
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Dates
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Enumeration Date | 09/22/2015
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Last Update Date | 10/01/2020
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Provider Practice Location Address
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Address Line | 1700 E 4TH ST APT 2301
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City | AUSTIN
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State | TX
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Zip | 78702-0027
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Country | US
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Telephone | 603-931-6467
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 E 4TH ST APT 2301
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City | AUSTIN
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State | TX
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Zip | 78702-0027
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Country | US
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Telephone | 603-931-6467
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CG 60577530
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 68905
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License Number State | TX
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