Provider Demographics
NPI:1396353074
Name:ANSLEY, BRENNA
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:ANSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 S MAYS ST STE 200&202
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-6773
Mailing Address - Country:US
Mailing Address - Phone:737-484-0148
Mailing Address - Fax:
Practice Address - Street 1:1104 S MAYS ST STE 200&202
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-6773
Practice Address - Country:US
Practice Address - Phone:737-484-0148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203585106H00000X
TX82977101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203585OtherLMFT ASSOCIATE
TX82977OtherLPC INTERN