Most Relevant Information
Provider Data
| NPI Number: | 1003402553 |
| Provider Name: | TINA KHALED |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 12/18/2020 |
| Last Updated: | 12/18/2020 |
Provider Practice Location
17505 OLD JEFFERSON HWY
PRAIRIEVILLE
LA
707693930
Practice Location Phone/Fax
| Phone: | 9855003130 |
| Fax: |
Provider Mailing Location
10328 BROWNING DR
BATON ROUGE
LA
708154716
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |