Healthcare Provider Details

I. General information

NPI: 1063194975
Provider Name (Legal Business Name): THOMAS GEORGE CANNING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 LAMOILLE HWY STE 103
ELKO NV
89801-4397
US

IV. Provider business mailing address

1250 LAMOILLE HWY STE 103
ELKO NV
89801-4397
US

V. Phone/Fax

Practice location:
  • Phone: 775-777-1292
  • Fax:
Mailing address:
  • Phone: 775-777-1292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT3608
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: