Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-12-12173 | CA |
NPI | 1003156506 |
---|---|
Provider Name | Ms. Brandi Spence |
First Address | Encino, CA 91436-2914 |
Second Address | Encino, CA 91436-2914 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2013 |
Last Update Date | 20/02/2013 |