Individual
DR. SUPRIYA GHANTA
Active
Individual
DR. SUPRIYA GHANTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
L05605R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1328006
—
LA
01
—
L05605R
STATE LICENCE NUMBER
LA
Enumeration date
11/01/2006
Last updated
11/05/2021
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