Provider Demographics
NPI:1467009399
Name:BREWER, KARINA
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 GREEN OAKS RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-1706
Mailing Address - Country:US
Mailing Address - Phone:817-560-1139
Mailing Address - Fax:817-560-7039
Practice Address - Street 1:2751 GREEN OAKS RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-1706
Practice Address - Country:US
Practice Address - Phone:817-560-1139
Practice Address - Fax:817-560-7039
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-15-01276106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician