Individual
TAKASHI M MATLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
339 JOY DR, HOT SPRINGS NATIONAL PARK, AR 71913-8913
(501) 551-1079
Mailing address
316 WALNUT ST, HOT SPRINGS NATIONAL PARK, AR 71901-3105
(501) 551-1079
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/21/2020
Last updated
09/21/2020
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