Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | 0-15-6638 | CO |
Y | 106E00000X | Assistant Behavior Analyst | 0-15-6638 |
NPI | 1083067185 |
---|---|
Provider Name | Mr. Amir Mehdi Ansari Ghaleh |
First Address | Woodbridge, VA 22191-4180 |
Second Address | Fredericksburg, VA 22407-0141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2016 |
Last Update Date | 20/03/2020 |