Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 322 | TN |
NPI | 1013305879 |
---|---|
Provider Name | Gabrielle Vega |
First Address | Clarksville, TN 37043-6329 |
Second Address | Clarksville, TN 37043-6329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2015 |
Last Update Date | 30/03/2021 |