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General NPI Number Information
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NPI Number | 1144173790
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Entity Type | Individual
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Provider Name | MR. BRADEN DONOVAN FLACK
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Gender | Male
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Dates
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Enumeration Date | 02/16/2026
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Last Update Date | 02/16/2026
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Provider Practice Location Address
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Address Line | 1818 S AUSTRALIAN AVE STE 420
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-6447
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Country | US
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Telephone | 561-708-5880
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 WINDY HILL RD
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City | HARKER HEIGHTS
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State | TX
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Zip | 76548-2288
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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 | 45927384
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License Number State | TX
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