Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-14-16138 | TX |
N | 103K00000X | Behavior Analyst | 1920 | TX |
NPI | 1003407552 |
---|---|
Provider Name | Dr. Kelly M. Carrero |
First Address | Plano, TX 75093-3217 |
Second Address | Plano, TX 75093-3217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2021 |
Last Update Date | 28/01/2021 |