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General NPI Number Information
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NPI Number | 1619380581
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Entity Type | Organization
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Legal Business Name | PROACTIVE AUTISM SOLUTIONS, INC.
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Dates
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Enumeration Date | 06/08/2014
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Last Update Date | 06/08/2014
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Provider Practice Location Address
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Address Line | 6767 W CHARLESTON BLVD STE. 150
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City | LAS VEGAS
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State | NV
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Zip | 89146-9073
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Country | US
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Telephone | 760-291-7160
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Fax |
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Provider Business Mailing Address
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Address Line | 6767 W CHARLESTON BLVD STE. 150
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City | LAS VEGAS
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State | NV
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Zip | 89146-9073
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Country | US
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Telephone | 760-291-7160
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND DIRECTOR OF COMPANY
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Name | ANGELA PATRICELLI
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Credential | BCBA, LBA
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Telephone | 760-291-7160
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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 | LBA0042
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License Number State | NV
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