MEDICARE: BRACKINS & ASSOCIATES

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	10580	TX
2	1041C0700X	Clinical Social Worker	11795	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1518177856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRACKINS & ASSOCIATES

Provider Business Mailing Address
First Line	:	525 N SAM HOUSTON PKWY E
Second Line	:	SUITE 597
City	:	HOUSTON
State	:	TX
Zip	:	77060-4037
Country	:	US
Telephone Number	:	281-272-1115
Fax Number	:	281-272-1117

Provider Business Practice Location Address
First Line	:	525 N SAM HOUSTON PKWY E
Second Line	:	SUITE 597
City	:	HOUSTON
State	:	TX
Zip	:	77060-4037
Country	:	US
Telephone Number	:	281-272-1115
Fax Number	:	281-272-1117

Authorized Official
Title or Position	:	SOLE PROPRIETOR/PSYCHOTHERAPIST
Name	:	MRS. DORIS GAIL BRACKINS
Credential	:	LCSW, SAP
Telephone Number	:	281-272-1115

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/28/2009

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Directions to “BRACKINS & ASSOCIATES ” Practice Location

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