Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-18-32520 |
NPI | 1003382953 |
---|---|
Provider Name | Tyler Bond |
First Address | Silver Spring, MD 20910-5676 |
Second Address | Silver Spring, MD 20910-5676 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2018 |
Last Update Date | 25/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1-18-32520 | BCBA CERTIFICATE (01) |