1528127040 NPI number — WILLIAM BRAD BRAGER MA, LPC

Table of content: (NPI 1003050139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528127040 NPI number — WILLIAM BRAD BRAGER MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRAGER
Provider First Name:
WILLIAM
Provider Middle Name:
BRAD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528127040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 HOLCOMBE BLVD
Provider Second Line Business Mailing Address:
SUITE 3406
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77030-4222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-459-4384
Provider Business Mailing Address Fax Number:
713-781-3756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
808 TRAVIS ST
Provider Second Line Business Practice Location Address:
SUITE 1507
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77002-5706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-459-4384
Provider Business Practice Location Address Fax Number:
713-781-3756
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LPC 10012 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3860LC . This is a "BLUE CROSS PROV NR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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