BRD Professional Psychology PLLC

Primary specialty

Counseling PsychologistTaxonomy code 103TC1900X

Legal business name

BRD PROFESSIONAL PSYCHOLOGY PLLC

Practice address

3617 W Pioneer Pkwy Ste 100
Pantego, TX 76013-4504

Phone

(814) 217-5180

NPI assigned

Jun 27, 2017

Last updated

Nov 10, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brendel Doss, PHD

Title

Owner

Phone

(817) 217-5180

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1498521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731196800000",
    "number": "1598285835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3617 W PIONEER PKWY STE 100",
            "city": "PANTEGO",
            "state": "TX",
            "postal_code": "760134504",
            "telephone_number": "814-217-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3617 W PIONEER PKWY STE 100",
            "city": "PANTEGO",
            "state": "TX",
            "postal_code": "760134504",
            "telephone_number": "814-217-5180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRD PROFESSIONAL PSYCHOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-27",
        "last_updated": "2024-11-10",
        "certification_date": "2024-11-10",
        "status": "A",
        "authorized_official_last_name": "DOSS",
        "authorized_official_first_name": "BRENDEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-217-5180",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.