Healthcare Provider Details

I. General information

NPI: 1649939901
Provider Name (Legal Business Name): AALIYAH N JOHNSON WALLS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 W CHARLESTON BLVD STE C
LAS VEGAS NV
89102-2258
US

IV. Provider business mailing address

3880 SILVER DOLLAR AVE # 18-202
LAS VEGAS NV
89102-7501
US

V. Phone/Fax

Practice location:
  • Phone: 702-960-0222
  • Fax:
Mailing address:
  • Phone: 725-243-9013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: