MEDICARE: BROOKLYN MAKENZIE MADDOX

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	BACB1604838	TX

General Provider Information

NPI Number	:	1265364582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKLYN MAKENZIE MADDOX

Provider Business Mailing Address
First Line	:	9120 PERIDOT WAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-5116
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 REGENCY PKWY
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-5090
Country	:	US
Telephone Number	:	682-400-0305
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “ BROOKLYN MAKENZIE MADDOX ” Practice Location

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