Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-14-15212 | CA |
N | 103TS0200X | School Psychologist | 3101 | CA |
NPI | 1043663529 |
---|---|
Provider Name | Eby Kent |
First Address | Huntington Beach, CA 92649-2432 |
Second Address | Newport Beach, CA 92660-7929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2016 |
Last Update Date | 19/07/2016 |