Provider Demographics
NPI:1700329364
Name:DONNENFIELD, EMILY BYRD
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:BYRD
Last Name:DONNENFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3714 BRUCE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-6104
Mailing Address - Country:US
Mailing Address - Phone:210-854-3770
Mailing Address - Fax:
Practice Address - Street 1:4922 LOCUST ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4040
Practice Address - Country:US
Practice Address - Phone:832-834-7980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM378490103TS0200X
247200000X
1-18-32152103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other