Healthcare Provider Details

I. General information

NPI: 1013854579
Provider Name (Legal Business Name): SILVER STATE PEDIATRIC BEHAVIORAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1391 S JONES BLVD BLDG 1301
LAS VEGAS NV
89146-1200
US

IV. Provider business mailing address

1391 S JONES BLVD BLDG 1301
LAS VEGAS NV
89146-1200
US

V. Phone/Fax

Practice location:
  • Phone: 702-310-3720
  • Fax:
Mailing address:
  • Phone: 702-310-3720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DANIEL MATHIS
Title or Position: CEO
Credential:
Phone: 702-521-8332