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General NPI Number Information
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NPI Number | 1184006041
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Entity Type | Organization
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Legal Business Name | AUTISM CARE WEST LLC
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Dates
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Enumeration Date | 06/26/2015
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Last Update Date | 06/26/2015
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Provider Practice Location Address
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Address Line | 2500 CITRUS GARDEN CIR
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City | HENDERSON
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State | NV
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Zip | 89052-2387
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Country | US
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Telephone | 702-326-5996
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Fax | 702-912-4662
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Provider Business Mailing Address
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Address Line | 2500 CITRUS GARDEN CIR
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City | HENDERSON
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State | NV
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Zip | 89052-2387
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Country | US
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Telephone | 702-326-5996
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Fax | 702-912-4662
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Authorized Official
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Title or Position | OWNER, BEHAVIOR ANALYST
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Name | CHARLES E MARRIOTT
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Credential | M. ED., BCBA, LBA
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Telephone | 702-326-5996
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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 | LBA0048
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License Number State | NV
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