Healthcare Provider Details

I. General information

NPI: 1407710940
Provider Name (Legal Business Name): KRISTIE LYNN RUESCH BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIE LYNN MURTISHAW

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 MAVERICK ST
LAS VEGAS NV
89108-3824
US

IV. Provider business mailing address

2490 MAVERICK ST
LAS VEGAS NV
89108-3824
US

V. Phone/Fax

Practice location:
  • Phone: 702-799-1883
  • Fax: 702-799-1884
Mailing address:
  • Phone: 702-799-1883
  • Fax: 702-799-1884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA0831
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: