Provider Demographics
NPI:1063874683
Name:BRAZOS VALLEY MENTAL HEALTH AND WELLNESS, LLC
Entity type:Organization
Organization Name:BRAZOS VALLEY MENTAL HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAFERKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:979-777-1683
Mailing Address - Street 1:600 WALNUT HILL DR
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-4986
Mailing Address - Country:US
Mailing Address - Phone:979-777-1683
Mailing Address - Fax:
Practice Address - Street 1:1600 S DAY ST
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-4828
Practice Address - Country:US
Practice Address - Phone:979-777-1683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-23
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
TX37193103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty