Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | ||
N | 103K00000X | Behavior Analyst | FL | |
Y | 103K00000X | Behavior Analyst | 1-20-44510 | FL |
N | 106E00000X | Assistant Behavior Analyst | 0-19-10452 | FL |
N | 106S00000X | Behavior Technician |
NPI | 1083107635 |
---|---|
Provider Name | Katherine Camp |
First Address | Destin, FL 32541-1647 |
Second Address | Mary Esther, FL 32569-1990 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2018 |
Last Update Date | 28/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1083107635 | INDIVIDUAL (01) | FL |