MEDICARE: BROOK MADDEN BCBA

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	:	1861880023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOK MADDEN BCBA

Provider Business Mailing Address
First Line	:	PO BOX 28921
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89126-2921
Country	:	US
Telephone Number	:	702-350-1875
Fax Number	:	833-901-4030

Provider Business Practice Location Address
First Line	:	200 HOOVER AVE UNIT 1413
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6880
Country	:	US
Telephone Number	:	702-350-1875
Fax Number	:	833-901-4030

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

Provider Enumeration Date	:	12/22/2014
Last Update Date	:	05/16/2022

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Directions to “ BROOK MADDEN BCBA” Practice Location

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