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NPI Code Detail

MEDICARE: DR. MARC ALAN TEDOFF PH.D., BCBA, LBA

MEDICARE: DR. MARC ALAN TEDOFF PH.D., BCBA, LBA
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 AnalystLBA0005NV

General Provider Information

NPI Number : 1487945812
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARC ALAN TEDOFF PH.D., BCBA, LBA
Provider Business Mailing Address
First Line : 408 S JONES BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89107-2658
Country : US
Telephone Number : 702-502-8021
Fax Number : 888-688-9464
Provider Business Practice Location Address
First Line : 408 S JONES BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89107-2658
Country : US
Telephone Number : 702-502-8021
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2011
Last Update Date : 10/05/2021

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