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NPI Code Detail

MEDICARE: EASTER SEALS SOUTHERN NEVADA

MEDICARE: EASTER SEALS SOUTHERN NEVADA
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1336443951
Entity Type Code : Organization
Provider Name (Legal Business Name) : EASTER SEALS SOUTHERN NEVADA
Provider Business Mailing Address
First Line : 6200 W OAKEY BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-1103
Country : US
Telephone Number : 702-870-7050
Fax Number :
Provider Business Practice Location Address
First Line : 6200 W OAKEY BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89146-1103
Country : US
Telephone Number : 702-870-7050
Fax Number :
Authorized Official
Title or Position : CEO
Name : MR. BRIAN MALCOLM PATCHETT
Credential : MASTERS
Telephone Number : 702-870-7050
Provider Enumeration Date : 12/23/2010
Last Update Date : 12/23/2010

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Directions to “EASTER SEALS SOUTHERN NEVADA ” Practice Location

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