Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1114496106 |
---|---|
Provider Name | Priscilla Thomas |
First Address | Santa Maria, CA 93455-1630 |
Second Address | Santa Maria, CA 93455-6819 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2018 |
Last Update Date | 19/11/2018 |