Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-15-19377 | KS |
NPI | 1003482845 |
---|---|
Provider Name | Tracy Livingston |
First Address | Lenexa, KS 66215-4002 |
Second Address | Lenexa, KS 66215-4002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2021 |
Last Update Date | 02/06/2021 |