Most Relevant Information
Provider Data
| NPI Number: | 1003356577 |
| Provider Name: | NICOLE JUSTINE BROGDON MAC LPC LMFT |
| Entity Type: | Individual |
| Taxonomy Code: | 101YP2500X |
| Specialty: | Counselor |
| License Number: | 63068 |
Most Important Dates
| Enumeration Date: | 03/03/2017 |
| Last Updated: | 03/03/2017 |
Provider Practice Location
2720 BEE CAVES RD
AUSTIN
TX
787465642
Practice Location Phone/Fax
| Phone: | 5122175247 |
| Fax: | 5127320556 |
Provider Mailing Location
2720 BEE CAVES RD
AUSTIN
TX
787465642
Provider Mailing Phone/Fax
| Phone: | 5122175247 |
| Fax: | 5127320556 |