Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist |
NPI | 1073081808 |
---|---|
Provider Name | Kassinda King Bayo |
First Address | Tolleson, AZ 85353-8434 |
Second Address | Tolleson, AZ 85353-8434 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2018 |
Last Update Date | 09/11/2018 |