| |
905 Griffith Avenue Owensboro KY 42301 | |
(270) 315-7823 | |
Not Available |
Full Name | |
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Speciality | Behavior Technician |
Location | 905 Griffith Avenue, Owensboro, Kentucky |
Authorized Official Name and Position | William Kevin Thompson (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 2709937476 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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905 Griffith Ave Owensboro KY 42301-3603 Ph: (270) 315-7823 | 905 Griffith Avenue Owensboro KY 42301 Ph: (270) 315-7823 |
NPI Number | 1124558002 |
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Provider Enumeration Date | 06/14/2017 |
Last Update Date | 07/21/2022 |
Certification Date | 03/09/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1124558002 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103K00000X | Behavior Analyst | (* (Not Available)) | Secondary |
106S00000X | Behavior Technician | (* (Not Available)) | Primary |
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