Healthcare Provider Details

I. General information

NPI: 1043835846
Provider Name (Legal Business Name): ACHIEVING INDEPENDENCE CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12645 COOKS BAY CT
LAS VEGAS NV
89141-6117
US

IV. Provider business mailing address

12645 COOKS BAY CT
LAS VEGAS NV
89141-6117
US

V. Phone/Fax

Practice location:
  • Phone: 614-783-4936
  • Fax:
Mailing address:
  • Phone: 614-783-4936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: DR. GWEN ANN JOHNSON
Title or Position: CEO
Credential: BCBA-D
Phone: 614-783-4936