Healthcare Provider Details
I. General information
NPI: 1477416535
Provider Name (Legal Business Name): ROBERT J MARSH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1091 S CIMARRON RD STE A5
LAS VEGAS NV
89145-2445
US
IV. Provider business mailing address
1091 S CIMARRON RD STE A5
LAS VEGAS NV
89145-2445
US
V. Phone/Fax
- Phone: 702-389-5465
- Fax:
- Phone: 702-389-5465
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103K00000X |
| Taxonomy | Behavior Analyst |
| License Number | LBA1095 |
| License Number State | NV |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: