Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1013491539 |
---|---|
Provider Name | Ms. Iting Alice Lee |
First Address | Walnut Creek, CA 94598-2538 |
Second Address | Walnut Creek, CA 94598-2538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2018 |
Last Update Date | 31/10/2018 |