Active NPI
Brooke Wallace, M.A., BCBA
- Behavior Analyst
- Little Elm, TX
National Provider Identifier
1043743495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 11-3131-09
- Practice address
- 1513 Canary Dr
Little Elm, TX 75068-8460 - Phone
- (469) 569-4082
- NPI assigned
- Apr 4, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 11-3131-09 | TX | Primary |
Addresses
Primary practice location
1513 Canary Dr
Little Elm, TX 75068-8460
Mailing address
1513 Canary Dr
Little Elm, TX 75068-8460
Phone (469) 569-4082
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11-3131-09 | TX | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1491264000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491264000000",
"number": "1043743495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1513 CANARY DR",
"city": "LITTLE ELM",
"state": "TX",
"postal_code": "750688460",
"telephone_number": "469-569-4082"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1513 CANARY DR",
"city": "LITTLE ELM",
"state": "TX",
"postal_code": "750688460",
"telephone_number": "469-569-4082"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "BROOKE",
"credential": "M.A., BCBA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-04-04",
"last_updated": "2017-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "TX",
"license": "11-3131-09",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Little Elm, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.