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NPI Code Detail

MEDICARE: CHRISTINA EPIPHANY GRANT RBT

MEDICARE: CHRISTINA EPIPHANY GRANT RBT
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

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11043670300OTHERNVNPI

General Provider Information

NPI Number : 1558712141
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINA EPIPHANY GRANT RBT
Provider Business Mailing Address
First Line : 2362 N GREEN VALLEY PKWY
Second Line : BLDG S APT 319
City : HENDERSON
State : NV
Zip : 89014-3661
Country : US
Telephone Number : 702-542-5953
Fax Number :
Provider Business Practice Location Address
First Line : 731 MALL RING CIR STE 215
Second Line :
City : HENDERSON
State : NV
Zip : 89014-6691
Country : US
Telephone Number : 702-300-6818
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2016
Last Update Date : 06/25/2016

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Directions to “ CHRISTINA EPIPHANY GRANT RBT” Practice Location

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