Individual
BOUAGNAN JOHANN PITAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2425 E SOUTHLAKE BLVD, SOUTHLAKE, TX 76092-6674
(817) 442-0222
(817) 442-0223
Mailing address
2425 E SOUTHLAKE BLVD, SOUTHLAKE, TX 76092-6674
(817) 442-0222
(817) 442-0223
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT20121430
TX
Other
Enumeration date
07/08/2020
Last updated
07/08/2020
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