Healthcare Provider Details

I. General information

NPI: 1124534326
Provider Name (Legal Business Name): JORDAN TURLEY BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDAN FISHER

II. Dates (important events)

Enumeration Date: 12/26/2017
Last Update Date: 03/23/2021
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8670 W CHEYENNE AVE STE 110
LAS VEGAS NV
89129-7457
US

IV. Provider business mailing address

4440 STARDUSK FALLS AVE
NORTH LAS VEGAS NV
89084-4722
US

V. Phone/Fax

Practice location:
  • Phone: 725-202-1497
  • Fax:
Mailing address:
  • Phone: 720-985-4350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA0375
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-44960
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number15-04512
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: