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General NPI Number Information
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NPI Number | 1942694229
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Entity Type | Organization
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Legal Business Name | WHITE BRIDLE LEARNING AND THERAPY
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Dates
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Enumeration Date | 03/24/2015
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 660 KELLER SMITHFIELD RD
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City | KELLER
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State | TX
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Zip | 76248-4228
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Country | US
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Telephone | 972-740-0900
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Fax | 817-665-9197
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Provider Business Mailing Address
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Address Line | 615 THOMPSON ST
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City | IRVING
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State | TX
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Zip | 75061-7218
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Country | US
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Telephone | 972-740-0900
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Fax | 817-665-9197
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Authorized Official
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Title or Position | OWNER
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Name | BROOK BULLEN
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Credential |
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Telephone | 940-740-0900
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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 | 1084003
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License Number State | TX
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