MEDICARE: MR. BRADEN DONOVAN FLACK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	45927384	TX

General Provider Information

NPI Number	:	1144173790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRADEN DONOVAN FLACK

Provider Business Mailing Address
First Line	:	1100 WINDY HILL RD
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-2288
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1818 S AUSTRALIAN AVE STE 420
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6447
Country	:	US
Telephone Number	:	561-708-5880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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