Individual
MRS. BREANNA LUCKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
6455 S SHORE BLVD STE 400, LEAGUE CITY, TX 77573-5525
(855) 782-7822
Mailing address
16835 DEER CREEK DR STE 220, SPRING, TX 77379-4895
(281) 290-4411
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
5608
TX
106S00000X
Behavior Technician
18-04855
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18-04855
—
TX
Enumeration date
06/11/2018
Last updated
02/01/2023
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