Healthcare Provider Details

I. General information

NPI: 1669710646
Provider Name (Legal Business Name): JAMES TIMOTHY CHURCH BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2013
Last Update Date: 05/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7391 W CHARLESTON BLVD # 150
LAS VEGAS NV
89117-1577
US

IV. Provider business mailing address

5248 PALM PINNACLE AVE
LAS VEGAS NV
89139-5682
US

V. Phone/Fax

Practice location:
  • Phone: 702-396-0101
  • Fax: 702-222-0212
Mailing address:
  • Phone: 307-575-2044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA0080
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: