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General NPI Number Information
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NPI Number | 1174222947
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Entity Type | Individual
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Provider Name | GARRETT BLAKE HADLEY BCBA
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Gender | Male
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Dates
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Enumeration Date | 03/01/2023
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 15914 PLEASANT GREEN CIR
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City | TOMBALL
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State | TX
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Zip | 77377-2520
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Country | US
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Telephone | 385-343-3310
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Fax |
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Provider Business Mailing Address
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Address Line | 15914 PLEASANT GREEN CIR
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City | TOMBALL
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State | TX
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Zip | 77377-2520
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Country | US
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Telephone | 138-534-3331
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 4896
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License Number State | TX
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