Individual
TERESA BOUSSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
179 LUKENS MILL DR, COATESVILLE, PA 19320-3968
(215) 327-9591
Mailing address
179 LUKENS MILL DR, COATESVILLE, PA 19320-3968
(215) 327-9591
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
11/19/2013
Last updated
01/08/2020
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