Healthcare Provider Details

I. General information

NPI: 1780988386
Provider Name (Legal Business Name): MATTHEW ANSORGE TETERS LEHMAN LBA,BCBA,BCEA-F,BCPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2010
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 S JONES BLVD STE 3465
LAS VEGAS NV
89107
US

IV. Provider business mailing address

304 S JONES BLVD STE 3465
LAS VEGAS NV
89107-2623
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number000027
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA60807646
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number146.0124394
License Number StateVT
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-10-7411
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0145
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: