Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-20-42519 | SC |
NPI | 1003224353 |
---|---|
Provider Name | Angela C. Outen |
First Address | Bowling Green, KY 42104-3250 |
Second Address | Fort Mill, SC 29708-8035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2014 |
Last Update Date | 06/08/2021 |