Organization
REA THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLY L BRUDNICKI LCSW (OWNER)
(936) 395-1051
Entity
Organization
Contact information
Practice address
5900 BALCONES DR STE 6698, AUSTIN, TX 78731-4257
(936) 220-1190
Mailing address
5900 BALCONES DR STE 6698, AUSTIN, TX 78731-4257
(936) 220-1190
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
089.0134724
LCSW
VT
01
—
107534
LCSW
TX
01
—
149.024496
LCSW
IL
01
—
19021-130
SAC-IT
WI
01
—
9882-123
LCSW
WI
Enumeration date
06/29/2022
Last updated
08/19/2022
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