Healthcare Provider Details

I. General information

NPI: 1992674147
Provider Name (Legal Business Name): MS. BROOKE DYSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20718 PARK ROW DR
KATY TX
77449-5181
US

IV. Provider business mailing address

542 AMHERST ST STE B
NASHUA NH
03063-1016
US

V. Phone/Fax

Practice location:
  • Phone: 877-540-2970
  • Fax:
Mailing address:
  • Phone: 877-775-9860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number9237
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: