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Organization
MHMR AUTHORITY OF BRAZOS VALLEY
Active
Organization
MHMR AUTHORITY OF BRAZOS VALLEY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEN DANFORD (DIRECTOR ADMINISTRATIVE SERVICES)
(979) 822-6467
Entity
Organization
Contact information
Practice address
804 S TEXAS AVE, BRYAN, TX 77803-3946
(979) 220-2881
(979) 821-9486
Mailing address
804 S TEXAS AVE, BRYAN, TX 77803-3946
(979) 220-2881
(979) 821-9486
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
72167
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
72167
TEXAS STATE LICENSE
TX
Enumeration date
07/26/2016
Last updated
07/26/2016
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