Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003356585 |
---|---|
Provider Name | Billy Johnston |
First Address | Hialeah, FL 33016-5972 |
Second Address | Hialeah, FL 33016-5972 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2017 |
Last Update Date | 05/02/2018 |