Healthcare Provider Details

I. General information

NPI: 1093375099
Provider Name (Legal Business Name): BRYANT DAVID GILLMAN BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7261 W CHARLESTON BLVD STE 101
LAS VEGAS NV
89117-1679
US

IV. Provider business mailing address

7261 W CHARLESTON BLVD STE 101
LAS VEGAS NV
89117-1679
US

V. Phone/Fax

Practice location:
  • Phone: 702-396-0101
  • Fax:
Mailing address:
  • Phone: 702-396-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-42373
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: