Provider Demographics
NPI:1932977857
Name:ADDIS, BROOKE (RBT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:ADDIS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MR
Other - First Name:DAMON
Other - Middle Name:RYLAN
Other - Last Name:ADDIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:12615 ASHFORD HILLS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-3842
Mailing Address - Country:US
Mailing Address - Phone:713-827-0600
Mailing Address - Fax:
Practice Address - Street 1:6513 PRECINCT LINE RD # 200
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-4313
Practice Address - Country:US
Practice Address - Phone:682-257-3531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBACB1055489103K00000X
TXRBT-24-320627106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst