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General NPI Number Information
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NPI Number | 1013772250
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Entity Type | Individual
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Provider Name | BRIANNA LYNN LEATHERWOOD
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Gender | Female
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Dates
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Enumeration Date | 02/16/2024
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 7004 PINE FOREST RD STE G
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City | PENSACOLA
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State | FL
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Zip | 32526-3935
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Country | US
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Telephone | 850-982-9118
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Fax |
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Provider Business Mailing Address
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Address Line | 6754 MYSTIC LN
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City | PENSACOLA
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State | FL
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Zip | 32526-9018
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-24-327091
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License Number State |
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