Individual
KENYA ELIJUWAH HARVEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5060 N 19TH AVE STE 421, PHOENIX, AZ 85015-3214
(706) 457-7114
Mailing address
5060 N 19TH AVE STE 421, PHOENIX, AZ 85015-3214
(706) 457-7114
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0595777499
DRIVER LICENSE
GA
Enumeration date
01/09/2023
Last updated
09/05/2023
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