Individual
CODY LYLE HARSTAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5501 ANTIQUE ROSE WAY, RIVERBANK, CA 95367-9505
(866) 523-4268
Mailing address
PO BOX 399318, SAN FRANCISCO, CA 94139-9318
(866) 523-4268
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-24-75036
CA
Other
Enumeration date
02/16/2021
Last updated
02/20/2025
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