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General NPI Number Information
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NPI Number | 1316422603
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Entity Type | Individual
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Provider Name | NATHAN TRYON
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Gender | Male
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Dates
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Enumeration Date | 10/02/2018
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Last Update Date | 10/02/2018
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Provider Practice Location Address
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Address Line | 6363 FOREST PARK RD STE BL5.230
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City | DALLAS
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State | TX
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Zip | 75235-5479
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Country | US
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Telephone | 214-648-0102
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Fax |
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Provider Business Mailing Address
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Address Line | 21600 OXNARD ST
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City | WOODLAND HILLS
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State | CA
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Zip | 91367-4976
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Country | US
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Telephone | 818-345-2345
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | TX
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