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NPI Code Detail

MEDICARE: JACKLYN DREW MURPHY BCBA,LBA

MEDICARE: JACKLYN DREW MURPHY 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 Analyst1-20-40615GU

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10000OTHERDO NOT HAVE ONE

General Provider Information

NPI Number : 1710452578
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACKLYN DREW MURPHY BCBA,LBA
Provider Business Mailing Address
First Line : 6232 GUNDERSON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89103-3263
Country : US
Telephone Number : 702-901-3508
Fax Number :
Provider Business Practice Location Address
First Line : 9205 W RUSSELL RD STE 240
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-1425
Country : US
Telephone Number : 671-487-5493
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2018
Last Update Date : 08/13/2025

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