Individual
BLAINE STIGLETS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
15489 DEDEAUX RD, GULFPORT, MS 39503-2667
(228) 357-5671
Mailing address
2417 22ND AVE, GULFPORT, MS 39501-4624
(228) 380-0355
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-134263
MS
Other
Enumeration date
09/17/2020
Last updated
09/17/2020
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