Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003589136 |
---|---|
Provider Name | Mysti Yvonne Ludy |
First Address | Las Vegas, NV 89128-1409 |
Second Address | Reno, NV 89502-1413 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2021 |
Last Update Date | 26/07/2021 |