Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003179870 |
---|---|
Provider Name | Bethany Ann Harriage |
First Address | Lakeland, FL 33803-5994 |
Second Address | Riverview, FL 33579-4009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2012 |
Last Update Date | 18/06/2012 |