Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1020763 | TX |
NPI | 1013144153 |
---|---|
Provider Name | Mrs. Jennifer West Dantzler |
First Address | Houston, TX 77044-4436 |
Second Address | Humble, TX 77346-2502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2009 |
Last Update Date | 16/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1020763 | BCBA (01) |