Provider Demographics
NPI:1881363620
Name:HAGGERTY, BRANDALYN LEE (LPC)
Entity type:Individual
Prefix:
First Name:BRANDALYN
Middle Name:LEE
Last Name:HAGGERTY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BRADALYN
Other - Middle Name:LEE
Other - Last Name:DUDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6800 PARK TEN BLVD STE 200S
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-4293
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6812 BANDERA RD STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1378
Practice Address - Country:US
Practice Address - Phone:210-261-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81725101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health