Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 82819 | TX |
NPI | 1003571498 |
---|---|
Provider Name | Brady Prescott |
First Address | Amarillo, TX 79101-2401 |
Second Address | Amarillo, TX 79101-2401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2021 |
Last Update Date | 01/11/2021 |