MEDICARE: NIA BREKANIA COOK

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1598408411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIA BREKANIA COOK

Provider Business Mailing Address
First Line	:	2300 MCCUE RD APT 129
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-4634
Country	:	US
Telephone Number	:	407-398-5583
Fax Number	:

Provider Business Practice Location Address
First Line	:	2706 VERMILLION DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-4818
Country	:	US
Telephone Number	:	815-409-0524
Fax Number	:

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

Provider Enumeration Date	:	04/18/2022
Last Update Date	:	04/18/2022

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Directions to “ NIA BREKANIA COOK ” Practice Location

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