MEDICARE: BRANDY POWELL MA LPC RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1043165947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRANDY POWELL MA LPC RPT

Provider Business Mailing Address
First Line	:	401 N LOOP 336 W STE F
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77301-1200
Country	:	US
Telephone Number	:	936-697-6898
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 N LOOP 336 W STE F
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77301-1200
Country	:	US
Telephone Number	:	936-697-6898
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BRANDY POWELL
Credential	:
Telephone Number	:	936-697-6898

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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