Individual
BRIANNA RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15140 BADGER RANCH BLVD, WOODWAY, TX 76712
(254) 294-3685
Mailing address
15140 BADGER RANCH, WOODWAY, TX 76712
(254) 294-3685
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT20148048
BACB
TX
Enumeration date
12/14/2020
Last updated
06/15/2022
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