Provider Demographics
NPI:1912086026
Name:OBANNON, BRENT D (LPC, LCDC)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:D
Last Name:OBANNON
Suffix:
Gender:M
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 CARRIAGE ESTATES RD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-4425
Mailing Address - Country:US
Mailing Address - Phone:903-868-1813
Mailing Address - Fax:
Practice Address - Street 1:115 S TRAVIS ST
Practice Address - Street 2:303
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-5990
Practice Address - Country:US
Practice Address - Phone:903-813-0723
Practice Address - Fax:903-813-5452
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13223101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional