Most Relevant Information
Provider Data
| NPI Number: | 1003262155 |
| Provider Name: | CHANNARA TEP |
| Entity Type: | Individual |
| Taxonomy Code: | 103K00000X |
| Specialty: | Behavior Analyst |
| License Number: | F5763065 |
Most Important Dates
| Enumeration Date: | 05/09/2016 |
| Last Updated: | 05/09/2016 |
Provider Practice Location
625 S FAIR OAKS AVE
SUITE 200
PASADENA
CA
911052613
Practice Location Phone/Fax
| Phone: | 3233415580 |
| Fax: |
Provider Mailing Location
625 S FAIR OAKS AVE
SUITE 200
PASADENA
CA
911052613
Provider Mailing Phone/Fax
| Phone: | 3233415580 |
| Fax: |