Provider Demographics
NPI:1154896918
Name:THIBERVILLE, HENRI
Entity type:Individual
Prefix:
First Name:HENRI
Middle Name:
Last Name:THIBERVILLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:POINTBLANK
Mailing Address - State:TX
Mailing Address - Zip Code:77364-6034
Mailing Address - Country:US
Mailing Address - Phone:713-213-0428
Mailing Address - Fax:
Practice Address - Street 1:50 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:POINTBLANK
Practice Address - State:TX
Practice Address - Zip Code:77364-6034
Practice Address - Country:US
Practice Address - Phone:713-213-0428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-18-67392103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst