Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003389586 |
---|---|
Provider Name | Joshua Taylor Bouse |
First Address | Woodland Hills, CA 91367-7807 |
Second Address | Killeen, TX 76542-2000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2019 |
Last Update Date | 07/01/2019 |