Individual
MISS BETHANY STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.S.
Contact information
Practice address
111 S TREATY RD, MIAMI, OK 74354-5327
(918) 540-1511
Mailing address
3108 SE QUAKER RD, COLUMBUS, KS 66725-2312
(620) 875-9563
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
01/20/2014
Last updated
01/20/2014
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