Individual
LARYTHA BOUAKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
175 MARKET PLACE DR STE A, LOUISVILLE, KY 40229-4471
(502) 251-7002
(317) 520-8200
Mailing address
3500 DEPAUW BLVD STE 3070, INDIANAPOLIS, IN 46268-6135
(855) 324-0885
(317) 520-8200
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-191306
KY
Other
Enumeration date
11/02/2021
Last updated
11/02/2021
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