Psychological Consultants of the Brazos Valley PA

Primary specialty

PsychologistTaxonomy code 103T00000X

License

32062 Issued in TX

Legal business name

PSYCHOLOGICAL CONSULTANTS OF THE BRAZOS VALLEY PA

Practice address

2400 Broadmoor Dr
Ste C
Bryan, TX 77802

Phone

(979) 774-9255

Fax

(979) 774-9299

NPI assigned

Feb 8, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Bradley D Powell, PHDNPI 1699805929

Title

Diirector Owner

Phone

(979) 774-9255

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bradley Douglas Powell, PHD

  • Psychologist
  • Bryan, TX
  • NPI 1699805929
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1139356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1306819511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 BROADMOOR DR",
            "address_2": "STE C",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "77802",
            "telephone_number": "979-774-9255",
            "fax_number": "979-774-9299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 BROADMOOR DR",
            "address_2": "STE C",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "77802",
            "telephone_number": "979-774-9255",
            "fax_number": "979-774-9299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOLOGICAL CONSULTANTS OF THE BRAZOS VALLEY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIIRECTOR OWNER",
        "authorized_official_telephone_number": "979-774-9255",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "TX",
            "license": "32062",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0064LM",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Marcus M Purvis, MD

• Psychologist in Bryan, TX
• Providers in Bryan, TX by specialty
• Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.