| NPI | 1124563069 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINE BLOUGH Credentialing 866-287-2036 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2017-01-02 |
| Last Update Date | 2023-07-12 |