MEDICARE: BRAE MARVIN SALMOND LPC

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	101Y00000X	Counselor	98923	TX

General Provider Information

NPI Number	:	1902474109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRAE MARVIN SALMOND LPC

Provider Business Mailing Address
First Line	:	3835 N FREEWAY BLVD STE 100
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-1954
Country	:	US
Telephone Number	:	916-576-7900
Fax Number	:	916-277-9380

Provider Business Practice Location Address
First Line	:	7859 WALNUT HILL LN STE 310
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-5615
Country	:	US
Telephone Number	:	855-501-1004
Fax Number	:	833-559-1132

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

Provider Enumeration Date	:	06/14/2021
Last Update Date	:	10/01/2025

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