MEDICARE: DETREVION BRIERRE JAMES MS, BCBA, LBA

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	101YM0800X	Mental Health Counselor	011720681	LA
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1518435684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DETREVION BRIERRE JAMES MS, BCBA, LBA

Provider Business Mailing Address
First Line	:	16143 TALONCREST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-5036
Country	:	US
Telephone Number	:	832-301-1721
Fax Number	:

Provider Business Practice Location Address
First Line	:	5610 W RIVER PARK DR
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-7902
Country	:	US
Telephone Number	:	713-331-7664
Fax Number	:

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

Provider Enumeration Date	:	11/07/2018
Last Update Date	:	01/16/2024

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