Healthcare Provider Details

I. General information

NPI: 1023653755
Provider Name (Legal Business Name): BRIANNA MARIE UNDERWOOD RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W LEBANON STE 212
FRISCO TX
75036-3404
US

IV. Provider business mailing address

1212 SUMMER LAKE TRL
CARROLLTON TX
75007-6217
US

V. Phone/Fax

Practice location:
  • Phone: 469-850-3992
  • Fax:
Mailing address:
  • Phone: 940-367-8456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-102626
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: