Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | ||
N | 106S00000X | Behavior Technician |
NPI | 1023576626 |
---|---|
Provider Name | Brooke E Elsea |
First Address | Simpsonville, SC 29681-4111 |
Second Address | Greenville, SC 29607-4833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2019 |
Last Update Date | 15/10/2021 |