Provider Demographics
NPI:1649937798
Name:FUENTES, BRANDI (RBT)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:FUENTES
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17201 BLACKHAWK BLVD APT 702
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-3435
Mailing Address - Country:US
Mailing Address - Phone:346-427-8152
Mailing Address - Fax:
Practice Address - Street 1:8603 BROADWAY ST STE 170
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8171
Practice Address - Country:US
Practice Address - Phone:281-540-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician