Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | OK |
NPI | 1164190252 |
---|---|
Provider Name | James Avery |
First Address | Oklahoma City, OK 73118-2028 |
Second Address | Midwest City, OK 73130-2323 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2021 |
Last Update Date | 02/09/2021 |