Healthcare Provider Details

I. General information

NPI: 1639965999
Provider Name (Legal Business Name): NDBI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3652 CALICO COVE CT
LAS VEGAS NV
89147-6801
US

IV. Provider business mailing address

3652 CALICO COVE CT
LAS VEGAS NV
89147-6801
US

V. Phone/Fax

Practice location:
  • Phone: 702-430-7660
  • Fax: 702-430-7660
Mailing address:
  • Phone: 315-256-6138
  • Fax: 702-430-7660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW LEHMAN
Title or Position: OWNER
Credential: LBA
Phone: 315-256-6138