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General NPI Number Information
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NPI Number | 1639694375
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Entity Type | Organization
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Legal Business Name | SIMPLE BEHAVIOR SOLUTIONS
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Dates
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Enumeration Date | 08/03/2017
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Last Update Date | 08/03/2017
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Provider Practice Location Address
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Address Line | 2151 VILLAGE WALK DR
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City | HENDERSON
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State | NV
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Zip | 89012-5734
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Country | US
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Telephone | 951-905-8652
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Fax | 951-905-8652
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Provider Business Mailing Address
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Address Line | 2151 VILLAGE WALK DR
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City | HENDERSON
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State | NV
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Zip | 89012-5734
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Country | US
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Telephone | 951-905-8652
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRYSTAL VAN VOORHIS
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Credential | MS, BCBA, LBA
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Telephone | 951-905-8652
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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 | LBA00106
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License Number State | NV
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