Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | IL | |
Y | 106S00000X | Behavior Technician | IL |
NPI | 1003370255 |
---|---|
Provider Name | Donnell Mccauley JR. |
First Address | West Frankfort, IL 62896-2210 |
Second Address | West Frankfort, IL 62896-2210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2019 |
Last Update Date | 22/01/2019 |