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General NPI Number Information
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NPI Number | 1982751822
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Entity Type | Individual
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Provider Name | EDWARD ALLEN BRUSHER LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | USA MEDCOM 2050 WORTH ROAD, SUITE 10
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-6010
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Country | US
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Telephone | 210-221-8235
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Fax | 210-221-7235
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Provider Business Mailing Address
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Address Line | 145 PHANTOM CRK
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City | CIBOLO
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State | TX
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Zip | 78108-4277
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Country | US
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Telephone | 210-375-4869
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Fax | 210-221-7235
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2364
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License Number State | GA
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