Basic Information
| Provider Information | |||||||||
| NPI: | 1497754345 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRELAND | ||||||||
| FirstName: | RICK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1970 RAWHIDE DR | ||||||||
| Address2: | SUITE 318 | ||||||||
| City: | ROUND ROCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786816957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123883638 | ||||||||
| FaxNumber: | 5123883634 | ||||||||
| Practice Location | |||||||||
| Address1: | 1970 RAWHIDE DR | ||||||||
| Address2: | SUITE 318 | ||||||||
| City: | ROUND ROCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786816957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123883638 | ||||||||
| FaxNumber: | 5123883634 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2005 | ||||||||
| LastUpdateDate: | 09/29/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 17467 | TX | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 151084402 | 05 | TX | MEDICAID | 151084401 | 05 | TX | MEDICAID | 84524L | 05 | TX | MEDICAID |