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General NPI Number Information
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NPI Number | 1669918561
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Entity Type | Individual
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Provider Name | LARRY CROOM JR.
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Gender | Male
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Dates
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Enumeration Date | 01/16/2017
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Last Update Date | 01/16/2017
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Provider Practice Location Address
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Address Line | 5836 S PECOS RD
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City | LAS VEGAS
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State | NV
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Zip | 89120-3418
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Country | US
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Telephone | 800-829-4933
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Fax |
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Provider Business Mailing Address
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Address Line | 5836 S PECOS RD
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City | LAS VEGAS
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State | NV
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Zip | 89120-3418
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Country | US
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Telephone | 800-829-4933
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 814779557
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License Number State | NV
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