Individual
BRENDA IM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
12803 WEST AVE APT 17106, SAN ANTONIO, TX 78216-1871
(210) 842-2991
Mailing address
12803 WEST AVE APT 17106, SAN ANTONIO, TX 78216-1871
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
TX
Other
Enumeration date
01/23/2018
Last updated
01/23/2018
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