Individual
MARYAH A PROVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5656 S POWER RD STE 121, GILBERT, AZ 85295-8489
(602) 610-4633
Mailing address
21600 OXNARD ST STE 1800, WOODLAND HILLS, CA 91367-7807
(818) 345-2345
(000) 000-0000
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
C16158146
AZ
Other
Enumeration date
07/17/2024
Last updated
07/17/2024
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