Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-21-51325 | CA |
N | 106S00000X | Behavior Technician |
NPI | 1003451907 |
---|---|
Provider Name | Raymond Shelley |
First Address | Gardena, CA 90248-3858 |
Second Address | Sacramento, CA 95827-2697 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2019 |
Last Update Date | 19/07/2021 |