Provider Demographics
NPI:1861226623
Name:SACKETT, BRAXTON ROSE
Entity type:Individual
Prefix:MISS
First Name:BRAXTON
Middle Name:ROSE
Last Name:SACKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:BRAX
Other - Middle Name:ROSE
Other - Last Name:SACKETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2500 SWEETGUM TRL APT 2015
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2877
Mailing Address - Country:US
Mailing Address - Phone:469-301-5122
Mailing Address - Fax:
Practice Address - Street 1:7500 SAN FELIPE ST STE 990
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-1708
Practice Address - Country:US
Practice Address - Phone:866-610-0580
Practice Address - Fax:866-611-1558
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician