Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-20-41371 | AZ |
N | 106S00000X | Behavior Technician |
NPI | 1003324104 |
---|---|
Provider Name | Meagan Sullivan |
First Address | Phoenix, AZ 85048-7639 |
Second Address | Phoenix, AZ 85048-7639 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2018 |
Last Update Date | 11/05/2020 |