Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1104390434 |
---|---|
Provider Name | Kala Minkley |
First Address | Arcata, CA 95521-9672 |
Second Address | Petaluma, CA 94952-5100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2019 |
Last Update Date | 21/01/2019 |