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NPI Code Detail

MEDICARE: MR. GEORGE RANDALL BRAZZEL MA, LPC, LMFT

MEDICARE: MR. GEORGE RANDALL BRAZZEL MA, LPC, LMFT
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
1101YP2500XProfessional Counselor9330TX

General Provider Information

NPI Number : 1164537460
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GEORGE RANDALL BRAZZEL MA, LPC, LMFT
Provider Business Mailing Address
First Line : 1345 SPACE PARK DR STE D
Second Line :
City : HOUSTON
State : TX
Zip : 77058-3469
Country : US
Telephone Number : 281-333-3246
Fax Number : 281-333-0221
Provider Business Practice Location Address
First Line : 1345 SPACE PARK DR STE D
Second Line :
City : HOUSTON
State : TX
Zip : 77058-3469
Country : US
Telephone Number : 281-333-3246
Fax Number : 281-333-0221
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2006
Last Update Date : 07/08/2007

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