Healthcare Provider Details

I. General information

NPI: 1730678046
Provider Name (Legal Business Name): ELIZABETH SEXTON BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13765 RANCHO VERDE DR
RENO NV
89521-7330
US

IV. Provider business mailing address

13765 RANCHO VERDE DR
RENO NV
89521-7330
US

V. Phone/Fax

Practice location:
  • Phone: 775-762-8712
  • Fax:
Mailing address:
  • Phone: 775-762-8712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCI0249
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA0047
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: