=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376888487
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JRT DEVELOPMENT SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2012
-----------------------------------------------------
Last Update Date | 11/29/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1403 SILENT SUNSET AVE
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-810-2422
-----------------------------------------------------
Fax | 702-586-3955
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6365 SIMMONS AVE 145-131
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-823-0056
-----------------------------------------------------
Fax | 702-586-3395
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. JULIA ROMI THOMAS
-----------------------------------------------------
Credential | LPT
-----------------------------------------------------
Telephone | 702-823-0056
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------