Basic Information
| Provider Information | |||||||||
| NPI: | 1578115796 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | BRANDT | ||||||||
| MiddleName: | JAYTON | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7327 SHADY VALE LN | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770403714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256687555 | ||||||||
| FaxNumber: | 3468316706 | ||||||||
| Practice Location | |||||||||
| Address1: | 2610 TECHNOLOGY FOREST BLVD | ||||||||
| Address2: | |||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773813904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3468316690 | ||||||||
| FaxNumber: | 3468316706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2019 | ||||||||
| LastUpdateDate: | 07/09/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 202646 | TX | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.