Provider Demographics
NPI:1174222947
Name:HADLEY, GARRETT BLAKE (BCBA)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:BLAKE
Last Name:HADLEY
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15914 PLEASANT GREEN CIR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-2520
Mailing Address - Country:US
Mailing Address - Phone:138-534-3331
Mailing Address - Fax:
Practice Address - Street 1:15914 PLEASANT GREEN CIR
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-2520
Practice Address - Country:US
Practice Address - Phone:385-343-3310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4896103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst