Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 02011676 |
NPI | 1093300428 |
---|---|
Provider Name | Morgan T Mendenhall |
First Address | Anderson, SC 29621-6715 |
Second Address | Greenville, SC 29607-4833 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2021 |
Last Update Date | 08/03/2021 |