Individual
KELLIE-ANN M HARVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2522 E 70TH ST, SHREVEPORT, LA 71105-4002
(318) 795-3388
Mailing address
3925 ADDISON AVE, SHREVEPORT, LA 71107-3113
(318) 518-4498
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
R-10899
LA
Other
Enumeration date
03/02/2022
Last updated
03/02/2022
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