Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106E00000X | Assistant Behavior Analyst |
NPI | 1114561404 |
---|---|
Provider Name | Stella Trevino Anderson |
First Address | Austin, TX 78757-2316 |
Second Address | Austin, TX 78704-6915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2019 |
Last Update Date | 04/11/2019 |