Healthcare Provider Details

I. General information

NPI: 1295157287
Provider Name (Legal Business Name): PUZZLE PIECES AUTISM AND BEHAVIORAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 PAINTED MIRAGE RD SUITE 320
LAS VEGAS NV
89149-4581
US

IV. Provider business mailing address

5550 PAINTED MIRAGE RD SUITE 320
LAS VEGAS NV
89149-4581
US

V. Phone/Fax

Practice location:
  • Phone: 702-818-1702
  • Fax:
Mailing address:
  • Phone: 702-818-1702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberNV20141004089
License Number StateNV

VIII. Authorized Official

Name: JAMES SUMMERS I
Title or Position: EXECUTIVE DIRECTOR
Credential: MA, BCBA
Phone: 702-818-1702