Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1053076935 |
---|---|
Provider Name | Joyce Grisham |
First Address | Checotah, OK 74426-0905 |
Second Address | Checotah, OK 74426-2439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2021 |
Last Update Date | 04/11/2021 |