Provider Demographics
NPI:1831638477
Name:WHITE, BRIDGETTE LEA (BCBA)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:LEA
Last Name:WHITE
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 1:611 ROCKMEAD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2294
Mailing Address - Country:US
Mailing Address - Phone:281-713-8980
Mailing Address - Fax:281-713-8938
Practice Address - Street 1:7435 HIGHWAY 6 STE F
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-5135
Practice Address - Country:US
Practice Address - Phone:281-713-8980
Practice Address - Fax:281-713-8938
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1711103K00000X
TX1-16-24592103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst