NPIMap

Organization Active NPI

Brazos Valley Mental Health and Wellness, LLC

  • Clinical Psychologist
  • Brenham, TX
National Provider Identifier
1063874683
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
37193 Issued in TX
Legal business name
BRAZOS VALLEY MENTAL HEALTH AND WELLNESS, LLC
Practice address
1600 S Day St
Brenham, TX 77833-4828
Phone
(979) 777-1683
NPI assigned
Mar 23, 2016
Last updated
Oct 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Sherry Haferkamp, PSY.D.
Title
Clinical Psychologist
Phone
(979) 777-1683

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 37193 TX Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

1600 S Day St
Brenham, TX 77833-4828

Mailing address

600 Walnut Hill Dr
Brenham, TX 77833-4986
Phone (979) 777-1683

Other practice location 1

2748 Longmire Dr
College Station, TX 77845-5424
Phone (979) 777-1683

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170510000818 TX Part B Supplier - Clinic/Group Practice 8123305661 Receives reassigned benefits from 1 practitioner
Practice locations: Brenham, TX

National Provider Directory

National Provider Directory

Locations

1600 S Day St
Brenham, TX 77833
Phone (979) 777-1683

117 Royal St
Bryan, TX 77801
Phone (979) 777-1683

2748 Longmire Dr
College Station, TX 77845
Phone (979) 777-1683

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1458691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729123200000",
    "number": "1063874683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 WALNUT HILL DR",
            "city": "BRENHAM",
            "state": "TX",
            "postal_code": "778334986",
            "telephone_number": "979-777-1683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 S DAY ST",
            "city": "BRENHAM",
            "state": "TX",
            "postal_code": "778334828",
            "telephone_number": "979-777-1683"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2748 Longmire Dr",
            "address_purpose": "LOCATION",
            "city": "College Station",
            "state": "TX",
            "postal_code": "778455424",
            "country_code": "US",
            "telephone_number": "979-777-1683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BRAZOS VALLEY MENTAL HEALTH AND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-23",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A",
        "authorized_official_last_name": "HAFERKAMP",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "979-777-1683",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "37193",
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brenham, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.