Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-16-7215 | TX |
NPI | 1164964417 |
---|---|
Provider Name | Kayla Phillips |
First Address | Richardson, TX 75080-2689 |
Second Address | Richardson, TX 75080-2689 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2016 |
Last Update Date | 16/11/2016 |