Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003365479 |
---|---|
Provider Name | Cameron Montgomery Scallan |
First Address | Farmers Branch, TX 75244-4305 |
Second Address | Farmers Branch, TX 75244-4305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2016 |
Last Update Date | 27/09/2016 |