Individual
CANNON TYLER OUSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2620 FORUM BLVD STE E, COLUMBIA, MO 65203-5454
(573) 615-0114
Mailing address
2620 FORUM BLVD STE E, COLUMBIA, MO 65203-5454
(573) 615-0114
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
RBT-19-85713
MO
Other
Enumeration date
02/27/2020
Last updated
02/27/2020
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