Individual
MITSURU KODAKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., B.C.B.A.
Contact information
Practice address
1424 HEMPHILL ST, FORT WORTH, TX 76104-4703
(817) 759-7942
(817) 665-0878
Mailing address
102 N 3RD ST, SANGER, TX 76266-4827
(940) 300-6854
(817) 665-0878
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-10-6877
TX
Other
Enumeration date
09/30/2010
Last updated
09/30/2010
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