Provider Demographics
NPI:1790592137
Name:VANCE, MAKENZIE (RBT)
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:
Last Name:VANCE
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 1:3830 FAWN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-1809
Mailing Address - Country:US
Mailing Address - Phone:832-499-5521
Mailing Address - Fax:
Practice Address - Street 1:1175 ADKINS RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-7413
Practice Address - Country:US
Practice Address - Phone:210-415-9626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-24-398677103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst