Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106S00000X | Behavior Technician | ||
Y | 106S00000X | Behavior Technician | 00002464 | CA |
NPI | 1003314188 |
---|---|
Provider Name | Marissa Overstreet |
First Address | Woodland Hills, CA 91367-4976 |
Second Address | Fresno, CA 93711-3516 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2018 |
Last Update Date | 24/01/2018 |