Provider Demographics
NPI:1497381602
Name:WHITE, BRIA (RBT)
Entity Type:Individual
Prefix:
First Name:BRIA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2913 OLD CHOCOLATE BAYOU RD
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8996
Mailing Address - Country:US
Mailing Address - Phone:832-632-2177
Mailing Address - Fax:
Practice Address - Street 1:5959 WEST LOOP S STE 202
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2420
Practice Address - Country:US
Practice Address - Phone:832-203-5826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-19-99266106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXRBT-19-99266OtherRBT