MEDICARE: ALBA BEHAVIORAL HEALTH PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1114806486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBA BEHAVIORAL HEALTH PC

Provider Business Mailing Address
First Line	:	3375 S RAINBOW BLVD UNIT 80691
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89180-8832
Country	:	US
Telephone Number	:	907-232-5282
Fax Number	:	844-305-0320

Provider Business Practice Location Address
First Line	:	3375 S RAINBOW BLVD UNIT 80691
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89180-8832
Country	:	US
Telephone Number	:	907-232-5282
Fax Number	:	844-305-0320

Authorized Official
Title or Position	:	TREASURER
Name	:	DAMON WILSON
Credential	:
Telephone Number	:	856-535-7079

Provider Enumeration Date	:	08/29/2025
Last Update Date	:	11/10/2025

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