Individual
KOURTNEY STAFFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3101 N 17TH AVE, PHOENIX, AZ 85015-5803
(602) 803-3902
Mailing address
3101 N 17TH AVE, PHOENIX, AZ 85015-5803
(602) 803-3902
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/27/2017
Last updated
07/21/2022
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