Individual
JULLYSA WYNELL CORRINNE FOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1720 N HAMILTON ST, SPOKANE, WA 99207-2474
(360) 915-6868
Mailing address
748 14TH AVE, LONGVIEW, WA 98632-2315
(360) 200-5419
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
106S00000X
Behavior Technician
Primary
61379883
WA
175T00000X
Peer Specialist
—
—
Other
Enumeration date
04/29/2019
Last updated
12/19/2024
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