Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | A1896003 | CA |
NPI | 1003382144 |
---|---|
Provider Name | Denean Lynn Overton-Russell |
First Address | Irvine, CA 92614-5554 |
Second Address | Irvine, CA 92614-5554 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2018 |
Last Update Date | 16/10/2018 |