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General NPI Number Information
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NPI Number | 1861901209
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Entity Type | Individual
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Provider Name | BRITTANY BLACKMON FENWICK PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/28/2017
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 1001 S DAIRY ASHFORD RD # 156
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City | HOUSTON
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State | TX
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Zip | 77077-2375
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Country | US
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Telephone | 334-246-1313
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Fax |
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Provider Business Mailing Address
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Address Line | 6445 FM 1463 RD # 160161
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City | KATY
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State | TX
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Zip | 77494-4027
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Country | US
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Telephone | 678-524-8595
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2117
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4604
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License Number State | TX
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