Individual
BENJAMIN SAMUEL FALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4301 S PINE ST STE 505, TACOMA, WA 98409-7208
(253) 292-4354
Mailing address
4301 S PINE ST STE 505, TACOMA, WA 98409-7208
(253) 292-4354
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
CBT.CB.61040659
WA
Other
Enumeration date
09/23/2020
Last updated
09/23/2020
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