Renee Lynn Brake
Individual provider Active NPI Behavior Technician · Nixa, MO
NPI 1104584457 · NPPES record last updated Dec 3, 2021
Key facts
- NPI
- 1104584457
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- License
- RBT-21-193688 (MO)
- Practice address
- 116 W Sherman Way Ste 1
Nixa, MO 65714-9022 - Phone
- (417) 298-0984
- NPI assigned
- Dec 3, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-21-193688 | MO | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Daytastic ABA, LLC | Current |
Accepting new patients |
Locations
116 W Sherman Way
Ste 1
Nixa, MO 65714
Phone (417) 298-0984
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-21-193688 | MO | Yes |
Addresses
Primary practice location
116 W Sherman Way Ste 1
Nixa, MO 65714-9022
Mailing address
116 W Sherman Way Ste 1
Nixa, MO 65714-9022
Phone (417) 298-0984
Other providers in Nixa, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 3, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.