Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 103K00000X | Behavior Analyst | ||
N | 106E00000X | Assistant Behavior Analyst |
NPI | 1164825642 |
---|---|
Provider Name | Enrique Leon |
First Address | Port Saint Lucie, FL 34983-1041 |
Second Address | Stuart, FL 34994-3503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2014 |
Last Update Date | 30/12/2019 |