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General NPI Number Information
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NPI Number | 1730960972
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Entity Type | Individual
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Provider Name | KYANNI BRUCE
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Gender | Female
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Dates
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Enumeration Date | 10/12/2023
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 12246 QUEENSTON BLVD STE G
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City | HOUSTON
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State | TX
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Zip | 77095-5355
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Country | US
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Telephone | 281-899-0146
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Fax |
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Provider Business Mailing Address
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Address Line | 8330 WILLOW PLACE DR S APT 510
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City | HOUSTON
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State | TX
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Zip | 77070-4681
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Country | US
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Telephone | 832-382-4777
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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-21-196395
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License Number State | TX
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