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General NPI Number Information
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NPI Number | 1457217937
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Entity Type | Organization
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Legal Business Name | CANYON FALLS LLC
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Dates
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Enumeration Date | 12/29/2025
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 5619 N 133RD AVE
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-8344
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Country | US
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Telephone | 602-435-3810
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Fax |
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Provider Business Mailing Address
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Address Line | 5619 N 133RD AVE
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-8344
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Country | US
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Telephone | 602-435-3810
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR/OWNER
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Name | KEVIN BROWN-GIBSON
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Credential |
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Telephone | 602-435-3810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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