Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | BACB416491 | CA |
N | 106S00000X | Behavior Technician |
NPI | 1023577517 |
---|---|
Provider Name | Hannah Aleis Boland |
First Address | Visalia, CA 93291-5369 |
Second Address | Visalia, CA 93291-5369 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2019 |
Last Update Date | 24/11/2020 |