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NPI Code Detail

MEDICARE: MONIQUE K. BRAGGS

MEDICARE: MONIQUE K. BRAGGS
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
1101YM0800XMental Health Counselor73342TX
2101YP2500XProfessional Counselor73342TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336660877
Entity Type Code : Organization
Provider Name (Legal Business Name) : MONIQUE K. BRAGGS
Provider Business Mailing Address
First Line : 4500 MERCANTILE PLAZA DR STE 300
Second Line :
City : FORT WORTH
State : TX
Zip : 76137-4206
Country : US
Telephone Number : 817-533-8741
Fax Number : 972-945-9252
Provider Business Practice Location Address
First Line : 4500 MERCANTILE PLAZA DR STE 300
Second Line :
City : FORT WORTH
State : TX
Zip : 76137-4206
Country : US
Telephone Number : 817-533-8741
Fax Number : 972-945-9252
Authorized Official
Title or Position : OWNER
Name : MS. MONIQUE K. BRAGGS
Credential : LPC
Telephone Number : 817-533-8741
Provider Enumeration Date : 07/06/2017
Last Update Date : 07/21/2022

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