Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003474677 |
---|---|
Provider Name | Mr. Roy Lee Jones JR. |
First Address | Woodland Hills, CA 91367-7807 |
Second Address | Southlake, TX 76092-5240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2019 |
Last Update Date | 30/05/2019 |