Individual
DR. MARK WILDMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
447 ROAD 1279, TUPELO, MS 38804-9653
(662) 523-2527
Mailing address
447 ROAD 1279, TUPELO, MS 38804-9653
(662) 523-2527
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
190077
MS
Other
Enumeration date
08/14/2019
Last updated
08/14/2019
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