Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1013205814 |
---|---|
Provider Name | Stacy Lynn Williams |
First Address | Mcalester, OK 74501-7030 |
Second Address | Mcalester, OK 74501-7030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2011 |
Last Update Date | 13/07/2011 |