Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 106E00000X | Assistant Behavior Analyst | OR | |
N | 106S00000X | Behavior Technician | OR |
NPI | 1124599576 |
---|---|
Provider Name | Ms. Darian K Fencl |
First Address | Colorado Springs, CO 80920-2202 |
Second Address | Pueblo, CO 81004-2127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2018 |
Last Update Date | 25/08/2020 |