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General NPI Number Information
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NPI Number | 1033564588
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Entity Type | Individual
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Provider Name | JAMIE JOHNSON BCBA
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Gender | Female
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Dates
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Enumeration Date | 05/03/2016
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Last Update Date | 02/26/2018
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Provider Practice Location Address
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Address Line | 630 S RANCHO DR STE A
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City | LAS VEGAS
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State | NV
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Zip | 89106-4873
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Country | US
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Telephone | 702-564-2453
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Fax | 702-527-5353
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Provider Business Mailing Address
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Address Line | 8405 SEA GLEN DR
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City | LAS VEGAS
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State | NV
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Zip | 89128-7180
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Country | US
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Telephone | 702-812-9381
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | LABA0006
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License Number State | NV
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