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General NPI Number Information
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NPI Number | 1912086026
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Entity Type | Individual
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Provider Name | BRENT D OBANNON LPC, LCDC
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Gender | Male
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 115 S TRAVIS ST 303
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City | SHERMAN
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State | TX
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Zip | 75090-5990
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Country | US
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Telephone | 903-813-0723
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Fax | 903-813-5452
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Provider Business Mailing Address
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Address Line | 521 CARRIAGE ESTATES RD
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City | SHERMAN
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State | TX
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Zip | 75092-4425
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Country | US
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Telephone | 903-868-1813
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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 | 13223
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License Number State | TX
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