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106 Circle Way St Lake Jackson TX 77566-5266 | |
| (281) 310-0632 | |
| (877) 503-0956 |
| Full Name | |
|---|---|
| Speciality | Behavior Analyst |
| Location | 106 Circle Way St, Lake Jackson, Texas |
| Authorized Official Name and Position | Tiffany N Crow (BEHAVIOR ANALYST) |
| Authorized Official Contact | 9795495002 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
105 Portulaca St Lake Jackson TX 77566-5054 Ph: (281) 310-0632 | 106 Circle Way St Lake Jackson TX 77566-5266 Ph: (281) 310-0632 |
| NPI Number | 1467199042 |
|---|---|
| Provider Enumeration Date | 05/16/2022 |
| Last Update Date | 01/02/2025 |
| Certification Date | 01/02/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467199042 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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