Individual
TYLER CREEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
2427 RUSSELLVILLE RD, BOWLING GREEN, KY 42101-3980
(270) 936-7472
Mailing address
3500 DEPAUW BLVD STE 3070, INDIANAPOLIS, IN 46268-6135
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
01/23/2020
Last updated
01/23/2020
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