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NPI Code Detail

MEDICARE: MR. BRENTON HENDERSON

MEDICARE: MR. BRENTON HENDERSON
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 : 1497188130
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRENTON HENDERSON
Provider Business Mailing Address
First Line : 9404 SHELLFISH CT
Second Line : STE. 100
City : LAS VEGAS
State : NV
Zip : 89117-0267
Country : US
Telephone Number : 702-981-1153
Fax Number :
Provider Business Practice Location Address
First Line : 9404 SHELLFISH CT
Second Line : STE. 100
City : LAS VEGAS
State : NV
Zip : 89117-0267
Country : US
Telephone Number : 702-981-1153
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2013
Last Update Date : 10/08/2014

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