Provider Demographics
NPI:1902522329
Name:DEDE, BRANDY TAYLOR (PHD)
Entity type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:TAYLOR
Last Name:DEDE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:LYNN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11771 MIRA LAGO BLVD APT 1145
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-6471
Mailing Address - Country:US
Mailing Address - Phone:903-926-5331
Mailing Address - Fax:
Practice Address - Street 1:11771 MIRA LAGO BLVD APT 1145
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-6471
Practice Address - Country:US
Practice Address - Phone:903-926-5331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33813103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool