Healthcare Provider Details

I. General information

NPI: 1679409312
Provider Name (Legal Business Name): MADISSON MOHLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 N PECOS RD STE C
HENDERSON NV
89074-7344
US

IV. Provider business mailing address

139 ARBOR WAY
HENDERSON NV
89074-2796
US

V. Phone/Fax

Practice location:
  • Phone: 800-789-3062
  • Fax:
Mailing address:
  • Phone: 702-203-6620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: