Healthcare Provider Details

I. General information

NPI: 1740838143
Provider Name (Legal Business Name): ANDREW SMITH KOPICH BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 E SUNSET RD STE 203
HENDERSON NV
89014-2260
US

IV. Provider business mailing address

1060 WIGWAM PKWY
HENDERSON NV
89074-8162
US

V. Phone/Fax

Practice location:
  • Phone: 702-547-6971
  • Fax: 702-547-6948
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-23-14278
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-79043
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: