Individual
MARLENE JIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSR
Contact information
Practice address
1001 W BROADWAY STE D, FARMINGTON, NM 87401-5638
(505) 325-0238
Mailing address
1001 W BROADWAY, FARMINGTON, NM 87401-5638
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
12/03/2019
Last updated
12/10/2019
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