Individual
KELLIE BRYSON CARR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
711 E MAIN ST STE 14, MEDFORD, OR 97504-7139
(813) 345-2345
Mailing address
822 W 12TH ST, MEDFORD, OR 97501-3422
(623) 363-1367
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
04/09/2018
Last updated
04/09/2018
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