MEDICARE: MARVIN K. BRAGGS PSY.D.

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1710795679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARVIN K. BRAGGS PSY.D.

Provider Business Mailing Address
First Line	:	7706 MEADOW RD APT 221
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-4806
Country	:	US
Telephone Number	:	214-900-1688
Fax Number	:

Provider Business Practice Location Address
First Line	:	6301 GASTON AVE STE 1212
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-3958
Country	:	US
Telephone Number	:	214-900-1688
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/24/2024
Last Update Date	:	12/24/2024

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