Healthcare Provider Details

I. General information

NPI: 1487242343
Provider Name (Legal Business Name): ACKERMAN AUTISM CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S RANCHO DR STE A&F
LAS VEGAS NV
89106-4873
US

IV. Provider business mailing address

630 S RANCHO DR STE A
LAS VEGAS NV
89106-4849
US

V. Phone/Fax

Practice location:
  • Phone: 702-998-9505
  • Fax:
Mailing address:
  • Phone: 702-998-9505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN HAGER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 702-844-4579