Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-14-6412 | IA |
NPI | 1134631609 |
---|---|
Provider Name | Kelsey Meyn |
First Address | Irvine, CA 92606-2417 |
Second Address | Colorado Springs, CO 80906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2017 |
Last Update Date | 01/06/2018 |