Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003389305 |
---|---|
Provider Name | Amy Nicole Garrison |
First Address | Woodland Hills, CA 91367-7807 |
Second Address | Clovis, CA 93611-4432 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2019 |
Last Update Date | 09/01/2019 |