Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1013330190 |
---|---|
Provider Name | Tynette Lathan |
First Address | North Las Vegas, NV 89032-3494 |
Second Address | North Las Vegas, NV 89032-3494 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2014 |
Last Update Date | 27/01/2014 |