MEDICARE: LATRICE RENEE JAMES

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1598293490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATRICE RENEE JAMES

Provider Business Mailing Address
First Line	:	5915 S RAINBOW BLVD STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2558
Country	:	US
Telephone Number	:	702-209-0370
Fax Number	:	702-761-6401

Provider Business Practice Location Address
First Line	:	5915 S RAINBOW BLVD STE 105
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2558
Country	:	US
Telephone Number	:	702-209-0370
Fax Number	:	702-761-6401

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

Provider Enumeration Date	:	05/23/2017
Last Update Date	:	07/21/2022

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