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NPI Code Detail

MEDICARE: MHMR AUTHORITY OF BRAZOS VALLEY

MEDICARE: MHMR AUTHORITY OF BRAZOS VALLEY
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 Counselor72167TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
172167OTHERTXTEXAS STATE LICENSE

General Provider Information

NPI Number : 1760935720
Entity Type Code : Organization
Provider Name (Legal Business Name) : MHMR AUTHORITY OF BRAZOS VALLEY
Provider Business Mailing Address
First Line : 804 S TEXAS AVE
Second Line :
City : BRYAN
State : TX
Zip : 77803-3946
Country : US
Telephone Number : 979-220-2881
Fax Number : 979-821-9486
Provider Business Practice Location Address
First Line : 804 S TEXAS AVE
Second Line :
City : BRYAN
State : TX
Zip : 77803-3946
Country : US
Telephone Number : 979-220-2881
Fax Number : 979-821-9486
Authorized Official
Title or Position : DIRECTOR ADMINISTRATIVE SERVICES
Name : KEN DANFORD
Credential :
Telephone Number : 979-822-6467
Provider Enumeration Date : 07/26/2016
Last Update Date : 07/26/2016

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804 S TEXAS AVE
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1912296013 — MHMR AUTHORITY OF BRAZOS VALLEY
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1396166245 — GREGORY BRIGANDO LPC
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1477060655 — DR. JESSICA LYNNE HALL PH.D.
Practice Location Address:
804 S TEXAS AVE
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1174030357 — MRS. DIANA HOFSTETTER LPC
Practice Location Address:
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1205323722 — ELIZABETH BOGGESS LPC
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Directions to “MHMR AUTHORITY OF BRAZOS VALLEY ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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