Provider Demographics
NPI:1891317111
Name:FLANAGAN, JACK T (RBT)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:T
Last Name:FLANAGAN
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10438 GRANT RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4406
Mailing Address - Country:US
Mailing Address - Phone:832-604-7696
Mailing Address - Fax:
Practice Address - Street 1:10438 GRANT RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4406
Practice Address - Country:US
Practice Address - Phone:832-604-7696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst