Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | 2076640 | OR |
NPI | 1003378936 |
---|---|
Provider Name | Melissa Nicole Beason |
First Address | Woodland Hills, CA 91367-7807 |
Second Address | Beaverton, OR 97005-9447 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2019 |
Last Update Date | 01/04/2019 |