Individual
BROOKE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., BCBA
Contact information
Practice address
1513 CANARY DR, LITTLE ELM, TX 75068-8460
(469) 569-4082
Mailing address
1513 CANARY DR, LITTLE ELM, TX 75068-8460
(469) 569-4082
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
11-3131-09
TX
Other
Enumeration date
04/04/2017
Last updated
04/04/2017
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