Provider Demographics
NPI:1154357747
Name:BRAZOS VALLEY PSYCHOLOGICAL SERVICES PA
Entity type:Organization
Organization Name:BRAZOS VALLEY PSYCHOLOGICAL SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ARREDONDO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:979-574-8801
Mailing Address - Street 1:704B E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77803-4706
Mailing Address - Country:US
Mailing Address - Phone:979-574-8801
Mailing Address - Fax:979-775-9079
Practice Address - Street 1:704B E 29TH ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77803-4706
Practice Address - Country:US
Practice Address - Phone:979-574-8801
Practice Address - Fax:979-775-9079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2014-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32759103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty