MEDICARE: CELESTIAL LEE DAVIES BCBA

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	106S00000X	Behavior Technician	RBT-16-19565	UT
2	103K00000X	Behavior Analyst	LBA0655	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467984930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELESTIAL LEE DAVIES BCBA

Provider Business Mailing Address
First Line	:	8350 W DESERT INN RD APT 2095
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-9125
Country	:	US
Telephone Number	:	435-218-1926
Fax Number	:

Provider Business Practice Location Address
First Line	:	7390 W SAHARA AVE STE 260
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2765
Country	:	US
Telephone Number	:	702-900-4320
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2017
Last Update Date	:	10/13/2022

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