Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003309071 |
---|---|
Provider Name | Carolyn Peters |
First Address | Mount Pleasant, MI 48858-4464 |
Second Address | Mount Pleasant, MI 48858-4464 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2018 |
Last Update Date | 13/06/2018 |