Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-06-2948 | TX |
NPI | 1003239161 |
---|---|
Provider Name | Andrea Gamble |
First Address | Carrollton, TX 75010-4427 |
Second Address | Carrollton, TX 75010-4427 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2014 |
Last Update Date | 27/01/2014 |