Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-17-28217 | CA |
N | 106E00000X | Assistant Behavior Analyst | 0-17-7943 | CA |
NPI | 1093228462 |
---|---|
Provider Name | Kyle White |
First Address | Santa Ana, CA 92705-7875 |
Second Address | Hermosa Beach, CA 90254-2225 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2017 |
Last Update Date | 25/01/2022 |