Provider Demographics
NPI:1316978703
Name:CARR, BRIAN D (CP)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:CARR
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709-22ND PLACE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410
Mailing Address - Country:US
Mailing Address - Phone:806-795-3911
Mailing Address - Fax:806-795-2315
Practice Address - Street 1:3709 22ND PL
Practice Address - Street 2:SUITE C
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1333
Practice Address - Country:US
Practice Address - Phone:806-795-3911
Practice Address - Fax:806-795-2315
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23763103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000F81C4Medicaid
TXR57763Medicare UPIN
TXP000F81C4Medicaid