Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | ||
Y | 103K00000X | Behavior Analyst | 1-17-26719 | MI |
NPI | 1003275769 |
---|---|
Provider Name | Steven Williford |
First Address | Lansing, MI 48910-2889 |
Second Address | Lansing, MI 48910-2889 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2016 |
Last Update Date | 02/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1336475532 | GROUP NPI (01) |