Healthcare Provider Details

I. General information

NPI: 1740522739
Provider Name (Legal Business Name): APPLIED BEHAVIOR TECHNOLOGIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5945 S LOS ALTOS PKWY STE 101
SPARKS NV
89436-2503
US

IV. Provider business mailing address

PO BOX 50843
SPARKS NV
89435-0843
US

V. Phone/Fax

Practice location:
  • Phone: 775-354-1380
  • Fax: 775-354-1474
Mailing address:
  • Phone: 775-354-1380
  • Fax: 775-354-1474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TINA LEE WALSH
Title or Position: MANAGER
Credential: MBA
Phone: 775-354-1380