Provider Demographics
NPI:1760094114
Name:BROWN, JENNIFER (BCBA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4159 SARASOTA SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-1465
Mailing Address - Country:US
Mailing Address - Phone:210-262-5859
Mailing Address - Fax:
Practice Address - Street 1:4159 SARASOTA SPRINGS CT
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-1465
Practice Address - Country:US
Practice Address - Phone:210-262-5859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-20-43433103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst