Provider Demographics
NPI:1508251281
Name:FONVILLE, BRANDI (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:FONVILLE
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 W SPRING CREEK PKWY
Mailing Address - Street 2:SUITE 602
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5283
Mailing Address - Country:US
Mailing Address - Phone:972-596-0035
Mailing Address - Fax:972-596-0030
Practice Address - Street 1:4105 W SPRING CREEK PKWY
Practice Address - Street 2:SUITE 602
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-5283
Practice Address - Country:US
Practice Address - Phone:972-596-0035
Practice Address - Fax:972-596-0030
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-15-18322103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst