Individual
BREANA NICOLE SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14864 COUNTY ROAD 433, TYLER, TX 75706-3206
(903) 636-7994
Mailing address
PO BOX 2572, LINDALE, TX 75771-8672
(903) 636-7994
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/29/2025
Last updated
05/29/2025
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