Healthcare Provider Details

I. General information

NPI: 1649188012
Provider Name (Legal Business Name): BRIELLE LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 W PROSPER TRL
PROSPER TX
75078-3741
US

IV. Provider business mailing address

3314 BEAR CREEK DR
MELISSA TX
75454-2584
US

V. Phone/Fax

Practice location:
  • Phone: 469-715-1143
  • Fax:
Mailing address:
  • Phone: 469-715-1143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-501522
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: