Healthcare Provider Details

I. General information

NPI: 1609076579
Provider Name (Legal Business Name): INNOVATIVE BEHAVIORAL SOLUTIONS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 SPRING MOUNTAIN RD SUITE 110
LAS VEGAS NV
89102-8751
US

IV. Provider business mailing address

4525 SPRING MOUNTAIN RD SUITE 110
LAS VEGAS NV
89102-8751
US

V. Phone/Fax

Practice location:
  • Phone: 702-485-6705
  • Fax: 702-485-6706
Mailing address:
  • Phone: 702-485-6705
  • Fax: 702-485-6706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: RICHARD JOSEPH THOMSON
Title or Position: SECRETARY/TREASURER
Credential: BCBA
Phone: 702-485-6705