Organization
PSYCHOLOGICAL CONSULTANTS OF THE BRAZOS VALLEY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY D POWELL PHD (DIIRECTOR OWNER)
(979) 774-9255
Entity
Organization
Contact information
Practice address
2400 BROADMOOR DR, STE C, BRYAN, TX 77802
(979) 774-9255
(979) 774-9299
Mailing address
2400 BROADMOOR DR, STE C, BRYAN, TX 77802
(979) 774-9255
(979) 774-9299
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
32062
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0064LM
BLUE CROSS
TX
Enumeration date
02/08/2006
Last updated
08/22/2020
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