Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | ||
Y | 106S00000X | Behavior Technician | RBT-17-30491 | IN |
NPI | 1003478173 |
---|---|
Provider Name | John Edward Miller |
First Address | Indianapolis, IN 46268-6135 |
Second Address | Newburgh, IN 47630-9366 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2019 |
Last Update Date | 17/09/2020 |