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General NPI Number Information
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NPI Number | 1629938667
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Entity Type | Organization
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Legal Business Name | MINDSPROUT ABA LLC
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Dates
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Enumeration Date | 11/13/2025
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 5139 FIJI ISLAND CT
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89031-0976
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Country | US
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Telephone | 213-222-6474
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Fax | 213-281-0521
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Provider Business Mailing Address
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Address Line | 5940 S RAINBOW BLVD # 1182
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City | LAS VEGAS
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State | NV
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Zip | 89118-2540
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Country | US
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Telephone | 213-222-6474
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Fax | 213-281-0521
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Authorized Official
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Title or Position | OWNER
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Name | BREONNA JACKSON
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Credential | MS, BCBA, LBA
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Telephone | 510-877-2786
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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 |
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License Number State |
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