Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | 010557591 | LA |
NPI | 1003317637 |
---|---|
Provider Name | Therese Danielle Briscoe I |
First Address | Woodland Hills, CA 91367-7807 |
Second Address | Lafayette, LA 70508-2528 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2018 |
Last Update Date | 28/02/2018 |