Provider Demographics
NPI:1679290191
Name:BROD EVINS, NATALIE ALLEENE (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ALLEENE
Last Name:BROD EVINS
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MANOR PL
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-4910
Mailing Address - Country:US
Mailing Address - Phone:713-855-8993
Mailing Address - Fax:
Practice Address - Street 1:115 N DIXIE DR STE 320
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5958
Practice Address - Country:US
Practice Address - Phone:979-292-8320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5436103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst