ELLYSE NICOLE PROVENCIO

SAN ANTONIO, TX
NPI1033899059
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy106S00000X Behavior Technician
Enumeration Date2023-07-24
Last Update Date2023-07-24
Business Address
ELLYSE NICOLE PROVENCIO
14235 BLANCO RD
SAN ANTONIO, TX 78216-7718
Phone number: 210-415-9626
Mailing Address
ELLYSE NICOLE PROVENCIO
25102 COOPER VLY
SAN ANTONIO, TX 78255-2320
Phone number: 915-667-7306
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