Provider Demographics
NPI:1548690100
Name:AGNEW, BRIAN (LCDC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:AGNEW
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 N. MLK
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75426
Mailing Address - Country:US
Mailing Address - Phone:903-427-2226
Mailing Address - Fax:
Practice Address - Street 1:106 N. MLK
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75426
Practice Address - Country:US
Practice Address - Phone:903-427-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7952101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)