Active NPI
Theresa Braddy
- Professional Counselor
- Lewisville, TX
National Provider Identifier
1780131417
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 68047
- Practice address
- 160 E Vista Ridge Mall Dr
1415
Lewisville, TX 75067-3716 - Phone
- (214) 531-0747
- Fax
- (210) 519-0316
- NPI assigned
- Sep 11, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 68047 | TX | Primary |
Addresses
Primary practice location
160 E Vista Ridge Mall Dr
1415
Lewisville, TX 75067-3716
Mailing address
1278 FM 407
Suite 109 Office #22
Lewisville, TX 75077-2200
Phone (214) 513-0747
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 68047 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473552000000",
"number": "1780131417",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1278 FM 407",
"address_2": "SUITE 109 OFFICE #22",
"city": "LEWISVILLE",
"state": "TX",
"postal_code": "750772200",
"telephone_number": "214-513-0747",
"fax_number": "210-519-0316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 E VISTA RIDGE MALL DR",
"address_2": "1415",
"city": "LEWISVILLE",
"state": "TX",
"postal_code": "750673716",
"telephone_number": "214-531-0747",
"fax_number": "210-519-0316"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADDY",
"first_name": "THERESA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-09-11",
"last_updated": "2016-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "68047",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lewisville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.