Provider Demographics
NPI:1447994512
Name:TRUEBLOOD, MACKENZIE LEIGH (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:LEIGH
Last Name:TRUEBLOOD
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 TRADEWINDS DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2328
Mailing Address - Country:US
Mailing Address - Phone:636-248-1477
Mailing Address - Fax:
Practice Address - Street 1:8570 SIENNA SPRINGS BLVD STE A
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459
Practice Address - Country:US
Practice Address - Phone:346-450-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5005103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst