MEDICARE: GWENDOLYN LEE BREHM M.ED., 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
1	101YM0800X	Mental Health Counselor	8983	TX
2	101YM0800X	Mental Health Counselor	3117	TX

General Provider Information

NPI Number	:	1770864589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLYN LEE BREHM M.ED., LPC, LMFT

Provider Business Mailing Address
First Line	:	17300 EL CAMINO REAL
Second Line	:	SUITE 107D
City	:	HOUSTON
State	:	TX
Zip	:	77058-2715
Country	:	US
Telephone Number	:	832-741-0266
Fax Number	:	281-486-8575

Provider Business Practice Location Address
First Line	:	17300 EL CAMINO REAL
Second Line	:	SUITE 107D
City	:	HOUSTON
State	:	TX
Zip	:	77058-2715
Country	:	US
Telephone Number	:	832-741-0266
Fax Number	:	281-486-8575

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

Provider Enumeration Date	:	09/07/2011
Last Update Date	:	09/07/2011

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