Provider Demographics
NPI:1548038433
Name:GUGGENHEIM, BREANNA MARIE (BCBA, TXLBA, MT-BC)
Entity type:Individual
Prefix:MS
First Name:BREANNA
Middle Name:MARIE
Last Name:GUGGENHEIM
Suffix:
Gender:F
Credentials:BCBA, TXLBA, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 PATRIOT PKWY
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-4748
Mailing Address - Country:US
Mailing Address - Phone:318-655-0214
Mailing Address - Fax:
Practice Address - Street 1:207 PATRIOT PKWY
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-4748
Practice Address - Country:US
Practice Address - Phone:318-655-0214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225A00000X
TX6447103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist