Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 167338 | KY |
N | 103K00000X | Behavior Analyst | 256 | OH |
N | 103K00000X | Behavior Analyst | COBA.256 | OH |
NPI | 1992152565 |
---|---|
Provider Name | Mrs. Alexandra Rene Daniels |
First Address | Indianapolis, IN 46268-6135 |
Second Address | Edgewood, KY 41017-2525 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2016 |
Last Update Date | 02/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1-16-21799 | BEHAVIOR ANALYST CERT (01) |