Healthcare Provider Details

I. General information

NPI: 1386763530
Provider Name (Legal Business Name): CHRIS HOLCOMB PHD., CCC-SLP, BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7261 W CHARLESTON BLVD #101
LAS VEGAS NV
89117-1636
US

IV. Provider business mailing address

7261 W CHARLESTON BLVD #101
LAS VEGAS NV
89117-1636
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP620
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA0027
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: