Individual
KEVIN PROVITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3505 OLD MILL RD NE, RIO RANCHO, NM 87144-6392
(740) 610-6599
Mailing address
3505 OLD MILL RD NE, RIO RANCHO, NM 87144-6392
(740) 610-6599
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/02/2024
Last updated
12/02/2024
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