=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528778768
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NCR BEHAVIOR SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2022
-----------------------------------------------------
Last Update Date | 09/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1050 E FLAMINGO ROAD SUITE 107, #1112
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89119-1406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-850-0907
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1050 E FLAMINGO ROAD SUITE 107, #1112
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-475-8240
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO/FOUNDER
-----------------------------------------------------
Name | NICOLE FLOYD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 267-475-8240
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------