Provider Demographics
NPI:1124703707
Name:TRAUMA RESOLUTION CENTER OF TEXAS, PLLC
Entity type:Organization
Organization Name:TRAUMA RESOLUTION CENTER OF TEXAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROGGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:281-643-7247
Mailing Address - Street 1:7915 FM 1960 RD W STE 209
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-5726
Mailing Address - Country:US
Mailing Address - Phone:281-643-7247
Mailing Address - Fax:
Practice Address - Street 1:7915 FM 1960 RD W STE 209
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5726
Practice Address - Country:US
Practice Address - Phone:281-643-7247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty