Provider Demographics
NPI:1538584776
Name:WAGUESPACK, BRITTANY LORREE (BCBA)
Entity type:Individual
Prefix:MS
First Name:BRITTANY
Middle Name:LORREE
Last Name:WAGUESPACK
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 1:2611 SILVER FALLS DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-1838
Mailing Address - Country:US
Mailing Address - Phone:409-313-7358
Mailing Address - Fax:
Practice Address - Street 1:10203 BIRCHRIDGE DR
Practice Address - Street 2:SUITE 230
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-2200
Practice Address - Country:US
Practice Address - Phone:409-313-7358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-13-14770103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst