Basic Information
| Provider Information | |||||||||
| NPI: | 1225144454 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRANDT | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4221 APPALOOSA DR | ||||||||
| Address2: | |||||||||
| City: | SANTA TERESA | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880089121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9158675483 | ||||||||
| FaxNumber: | 9155647867 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 SUNLAND PARK DR | ||||||||
| Address2: | BLDG 6, SUITE 400 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799125115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9158675483 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 26861 | TX | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 0066CT | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |