Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-20-40703 | CO |
NPI | 1003443987 |
---|---|
Provider Name | Kelly Tousley |
First Address | Montrose, CO 81402-3307 |
Second Address | Montrose, CO 81401-3986 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2020 |
Last Update Date | 20/04/2020 |