Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | E2057664 | CA |
Y | 106S00000X | Behavior Technician | E2057664 | CA |
NPI | 1003281767 |
---|---|
Provider Name | Kali Neal |
First Address | Covina, CA 91724 |
Second Address | Covina, CA 91724-3668 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2015 |
Last Update Date | 05/01/2017 |