Healthcare Provider Details

I. General information

NPI: 1427542406
Provider Name (Legal Business Name): NORTHERN NEVADA CENTER FOR BEHAVIORAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 EMBLEM ST
SPARKS NV
89436-9171
US

IV. Provider business mailing address

2411 EMBLEM ST
SPARKS NV
89436-9171
US

V. Phone/Fax

Practice location:
  • Phone: 775-335-6953
  • Fax:
Mailing address:
  • Phone: 775-335-6952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-03-1439
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIA STEVENSON
Title or Position: OWNER
Credential: PHD, BCBA-D, LBA
Phone: 775-335-6953