=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295157287
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PUZZLE PIECES AUTISM AND BEHAVIORAL SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2014
-----------------------------------------------------
Last Update Date | 01/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5550 PAINTED MIRAGE RD SUITE 320
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89149-4581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-818-1702
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5550 PAINTED MIRAGE RD SUITE 320
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89149-4581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-818-1702
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | JAMES SUMMERS I
-----------------------------------------------------
Credential | MA, BCBA
-----------------------------------------------------
Telephone | 702-818-1702
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | NV20141004089
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------