Provider Demographics
NPI:1194536862
Name:CAMPOS-BRENNER, PATRICIA LINDA (MA, LPC-ASSOCIATE)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:LINDA
Last Name:CAMPOS-BRENNER
Suffix:
Gender:F
Credentials:MA, LPC-ASSOCIATE
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:
Other - Last Name:CAMPOS-BRENNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPC-ASSOCIATE
Mailing Address - Street 1:1108 PAINTBRUSH CIR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5936
Mailing Address - Country:US
Mailing Address - Phone:979-220-0292
Mailing Address - Fax:
Practice Address - Street 1:309 N WASHINGTON AVE STE 12
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77803-5369
Practice Address - Country:US
Practice Address - Phone:800-689-0250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90671101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional