Individual
ETHAN BELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
310 E BROADWAY AVE, JACKSON, WY 83001-8636
(307) 257-5487
Mailing address
310 E BROADWAY AVE, JACKSON, WY 83001-8636
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-142304
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-20-142304
BACB
WY
Enumeration date
10/28/2020
Last updated
10/28/2020
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