Provider Demographics
NPI:1750175808
Name:CLARK, BRANDI RICHELE (LPC, CRC)
Entity type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:RICHELE
Last Name:CLARK
Suffix:
Gender:F
Credentials:LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 SWEETHEART LN
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-6894
Mailing Address - Country:US
Mailing Address - Phone:903-926-2801
Mailing Address - Fax:
Practice Address - Street 1:265 SWEETHEART LN
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-6894
Practice Address - Country:US
Practice Address - Phone:903-926-2801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18090101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional