Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 71758 | TX |
N | 101YM0800X | Mental Health Counselor | 71758 | TX |
N | 101YP1600X | Pastoral Counselor | 71758 | TX |
N | 101YS0200X | School Counselor | 71758 | TX |
NPI | 1225688476 |
---|---|
Provider Name | Brandi Goble Menard |
First Address | Graham, TX 76450-3132 |
Second Address | Graham, TX 76450-3132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2019 |
Last Update Date | 18/09/2019 |