Individual
BRYN ALEAH FAVAKEH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2530 RIDGE AVE, EVANSTON, IL 60201-2492
(847) 869-0892
Mailing address
2104 GREENBRIAR DR, SOUTHLAKE, TX 76092-8355
(817) 442-9022
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-16-15039
TX
Other
Enumeration date
07/06/2022
Last updated
07/06/2022
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