Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | 18-58037 | TX |
NPI | 1003309329 |
---|---|
Provider Name | Lama M Ghazal |
First Address | Austin, TX 78739-1900 |
Second Address | Irving, TX 75039-3540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2018 |
Last Update Date | 11/06/2018 |