Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003400318 |
---|---|
Provider Name | Minnie Bell Lockett |
First Address | Wellington, FL 33414-6391 |
Second Address | Wellington, FL 33414-6391 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2021 |
Last Update Date | 26/02/2021 |