Provider Demographics
NPI:1194696971
Name:BRUSTIE, CARSON
Entity type:Individual
Prefix:
First Name:CARSON
Middle Name:
Last Name:BRUSTIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 DECATUR WAY
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-8626
Mailing Address - Country:US
Mailing Address - Phone:972-987-5575
Mailing Address - Fax:
Practice Address - Street 1:4633 COIT RD STE 330
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-4930
Practice Address - Country:US
Practice Address - Phone:972-987-5575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-25-4030011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical