Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003402553 |
---|---|
Provider Name | Tina Khaled |
First Address | Baton Rouge, LA 70815-4716 |
Second Address | Prairieville, LA 70769-3930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2020 |
Last Update Date | 18/12/2020 |