MEDICARE: BRITTANY MATHIS

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

General Provider Information

NPI Number	:	1265918320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY MATHIS

Provider Business Mailing Address
First Line	:	2205 WILLIAMS TRACE BLVD STE 101
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-4443
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2205 WILLIAMS TRACE BLVD STE 101
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-4443
Country	:	US
Telephone Number	:	281-305-0034
Fax Number	:

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

Provider Enumeration Date	:	07/12/2018
Last Update Date	:	10/30/2023

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