Individual
BENJAMIN PHILLIP DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1126 BREEZY LN, BEREA, KY 40403-8659
(606) 875-1420
Mailing address
1126 BREEZY LN, BEREA, KY 40403-8659
(606) 875-1420
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
251789
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
251789
KENTUCKY APPLIED BEHAVIOR ANALYST LICENSING BOARD
KY
Enumeration date
06/10/2013
Last updated
07/06/2019
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