Healthcare Provider Details

I. General information

NPI: 1053660209
Provider Name (Legal Business Name): ACHIEVABLE BEHAVIOR STRATEGIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9167 W FLAMINGO RD
LAS VEGAS NV
89147
US

IV. Provider business mailing address

9167 W FLAMINGO RD
LAS VEGAS NV
89147-6472
US

V. Phone/Fax

Practice location:
  • Phone: 702-565-1894
  • Fax: 702-565-0056
Mailing address:
  • Phone: 702-565-1894
  • Fax: 702-565-0056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-02-0938
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMHC 279
License Number StateHI

VIII. Authorized Official

Name: JUSTIN KYRIANNIS
Title or Position: PRESIDENT
Credential: M.A, LBA, LMHC, BCBA
Phone: 702-250-4891