Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1164956710 |
---|---|
Provider Name | Savannah Phelan |
First Address | Culver City, CA 90230-6610 |
Second Address | Culver City, CA 90230-6610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2017 |
Last Update Date | 19/04/2017 |