Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | ||
N | 225XM0800X | Mental Health |
NPI | 1558856039 |
---|---|
Provider Name | Kara Grace |
First Address | Las Vegas, NV 89128-0280 |
Second Address | Las Vegas, NV 89128-0280 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2018 |
Last Update Date | 26/06/2018 |