Provider Demographics
NPI:1134974082
Name:BRODRECHT, SOPHIA GRACE (HIGHSCHOOL DIPLOMA)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:GRACE
Last Name:BRODRECHT
Suffix:
Gender:F
Credentials:HIGHSCHOOL DIPLOMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E HICKORY HILL RD
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-2914
Mailing Address - Country:US
Mailing Address - Phone:319-651-1094
Mailing Address - Fax:
Practice Address - Street 1:4491 LONG PRAIRIE RD STE 300
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2012
Practice Address - Country:US
Practice Address - Phone:469-687-9184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician