Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 2690 | TX |
NPI | 1013169010 |
---|---|
Provider Name | Mary Ann Tello |
First Address | Laredo, TX 78041-1964 |
Second Address | Laredo, TX 78041-1964 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2008 |
Last Update Date | 17/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
171436201 | (05) | TX |