Active NPI
Gail Cassandra Brothers, PH.D.
- Clinical Psychologist
- Fort Worth, TX
National Provider Identifier
1780761130
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 25595
- Practice address
- 6421 Camp Bowie Blvd
Suite 306
Fort Worth, TX 76116-5401 - Phone
- (817) 689-4744
- Fax
- (817) 207-0704
- NPI assigned
- Nov 1, 2006
- Last updated
- Jan 13, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 25595 | TX | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 25595 | TX |
Addresses
Primary practice location
6421 Camp Bowie Blvd
Suite 306
Fort Worth, TX 76116-5401
Mailing address
PO Box 101011
Fort Worth, TX 76185-1011
Phone (817) 689-4744
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1172603-04 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100709000568 | TX | Practitioner - Clinical Psychologist | 1557395191 | Practice locations: Benbrook, TX |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
6410 Southwest Blvd
Suite 212
Benbrook, TX 76109-3920
Phone (817) 689-4744
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25595 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452643200000",
"number": "1780761130",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 101011",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761851011",
"telephone_number": "817-689-4744",
"fax_number": "817-207-0704"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6421 CAMP BOWIE BLVD",
"address_2": "SUITE 306",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761165401",
"telephone_number": "817-689-4744",
"fax_number": "817-207-0704"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROTHERS",
"first_name": "GAIL",
"middle_name": "CASSANDRA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-01",
"last_updated": "2016-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "25595",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "TX",
"license": "25595",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1172603-04",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.