Provider Demographics
NPI:1093540155
Name:BRISENO-AMEZCUA, IVONNE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:IVONNE
Middle Name:
Last Name:BRISENO-AMEZCUA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16441 SPACE CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2015
Mailing Address - Country:US
Mailing Address - Phone:713-682-9660
Mailing Address - Fax:
Practice Address - Street 1:12234 SHADOW CREEK PKWY BLDG 7
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7330
Practice Address - Country:US
Practice Address - Phone:713-997-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst