Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 1-16-23367 | TN |
NPI | 1174075808 |
---|---|
Provider Name | Ms. Patricia Linnea Larsen |
First Address | Clarksville, TN 37040-3191 |
Second Address | Clarksville, TN 37043-1945 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2016 |
Last Update Date | 02/12/2018 |