Provider Demographics
NPI:1942046057
Name:SPEAR, BRESHAYE
Entity type:Individual
Prefix:
First Name:BRESHAYE
Middle Name:
Last Name:SPEAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 MOUNTAIN LION CIR STE 500
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-5725
Mailing Address - Country:US
Mailing Address - Phone:219-407-9941
Mailing Address - Fax:
Practice Address - Street 1:904 MOUNTAIN LION CIR STE 500
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-5725
Practice Address - Country:US
Practice Address - Phone:814-414-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-24-337596106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician