MEDICARE: RICHI ALLEN 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
1	106S00000X	Behavior Technician	BACB402645	NV

General Provider Information

NPI Number	:	1801307525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHI ALLEN RBT

Provider Business Mailing Address
First Line	:	313 AUTUMN PALACE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89144-4107
Country	:	US
Telephone Number	:	702-695-8350
Fax Number	:

Provider Business Practice Location Address
First Line	:	9480 S EASTERN AVE STE 273
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-8000
Country	:	US
Telephone Number	:	702-695-8350
Fax Number	:	702-695-8350

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

Provider Enumeration Date	:	10/20/2017
Last Update Date	:	10/20/2017

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Directions to “ RICHI ALLEN RBT” Practice Location

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