Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003430471 |
---|---|
Provider Name | Ashley King |
First Address | Shreveport, LA 71115-3333 |
Second Address | Shreveport, LA 71105-4002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2020 |
Last Update Date | 02/06/2020 |