MEDICARE: MR. TIMOTHY BRAIN SINNOTT I BEHAVIOR ANALYST

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	LBAT042011	NV
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1841556321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY BRAIN SINNOTT I BEHAVIOR ANALYST

Provider Business Mailing Address
First Line	:	2601 S PAVILION CENTER DR UNIT 2102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1818
Country	:	US
Telephone Number	:	702-523-5059
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 S PAVILION CENTER DR UNIT 2102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1818
Country	:	US
Telephone Number	:	702-523-5059
Fax Number	:

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

Provider Enumeration Date	:	04/09/2012
Last Update Date	:	06/17/2022

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