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General NPI Number Information
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NPI Number | 1225498348
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Entity Type | Organization
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Legal Business Name | GRANT A GIFT AUTISM FOUNDATION
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Dates
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Enumeration Date | 03/02/2016
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Last Update Date | 03/28/2016
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Provider Practice Location Address
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Address Line | 630 S RANCHO DR
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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 | 630 S RANCHO DR
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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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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. LYNDA TACHE
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Credential |
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Telephone | 702-564-2453
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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 | 0-14-5003
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License Number State | NV
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