Healthcare Provider Details

I. General information

NPI: 1649046020
Provider Name (Legal Business Name): VICTORIA MANON BEHAVIOR SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11041 S EASTERN AVE STE 109-247
HENDERSON NV
89052-4962
US

IV. Provider business mailing address

5325 S FORT APACHE RD STE D186
LAS VEGAS NV
89148-4665
US

V. Phone/Fax

Practice location:
  • Phone: 702-350-1231
  • Fax: 702-637-0779
Mailing address:
  • Phone: 702-350-1231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: JACQUELINE LAZOOTIN
Title or Position: CO-OWNER
Credential: BCBA
Phone: 917-716-1169