Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1093466880 |
---|---|
Provider Name | Mrs. Latisha Bradley |
First Address | Stuart, FL 34997-7462 |
Second Address | Houston, TX 77077-3448 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2022 |
Last Update Date | 12/01/2022 |