Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-14-15390 | CA |
NPI | 1013336692 |
---|---|
Provider Name | Tasia Wells |
First Address | Tarzana, CA 91356-3253 |
Second Address | Thousand Oaks, CA 91360-5828 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2014 |
Last Update Date | 10/04/2014 |