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Individual
MY MY HA
Active
Individual
MY MY HA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, BCBA
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-22-59598
FL
103K00000X
Behavior Analyst
1-22-59598
IN
106S00000X
Behavior Technician
RBT-19-99023
IN
Other
Enumeration date
10/02/2020
Last updated
08/02/2026
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