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General NPI Number Information
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NPI Number | 1922908623
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Entity Type | Individual
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Provider Name | GRECIA JAMILETH BRADFORD
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Gender | Female
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Dates
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Enumeration Date | 11/06/2026
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Last Update Date | 11/06/2026
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Provider Practice Location Address
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Address Line | 94-428 MOKUOLA ST STE 214A
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City | WAIPAHU
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State | HI
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Zip | 96797-3396
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Country | US
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Telephone | 808-944-2882
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Fax |
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Provider Business Mailing Address
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Address Line | 15600 YARBERRY DR
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City | ROANOKE
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State | TX
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Zip | 76262-3364
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Country | US
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Telephone | 682-718-2770
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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-26-2859277
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License Number State | TX
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