MEDICARE: BRANDI NICOLE FREEMAN BCBA

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	103K00000X	Behavior Analyst	1099	TX

General Provider Information

NPI Number	:	1750887956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI NICOLE FREEMAN BCBA

Provider Business Mailing Address
First Line	:	625 W CENTERVILLE RD STE 120
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75041-5428
Country	:	US
Telephone Number	:	214-853-3506
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 W CENTERVILLE RD
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75041-5456
Country	:	US
Telephone Number	:	972-905-5257
Fax Number	:

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

Provider Enumeration Date	:	04/05/2018
Last Update Date	:	08/08/2022

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