Healthcare Provider Details

I. General information

NPI: 1922513803
Provider Name (Legal Business Name): TRAVIS HAMMOND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-30521
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA0594
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: