Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 67918 | TX |
NPI | 1003227539 |
---|---|
Provider Name | Bradley Negrete |
First Address | Plano, TX 75023-6748 |
Second Address | Plano, TX 75023-6748 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2014 |
Last Update Date | 19/05/2014 |