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General NPI Number Information
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NPI Number | 1740527795
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Entity Type | Individual
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Provider Name | BRENDA SMITH BRAAM
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Gender | Female
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Dates
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Enumeration Date | 01/10/2013
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Last Update Date | 01/10/2013
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Provider Practice Location Address
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Address Line | 4616 W SAHARA AVE # 139
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City | LAS VEGAS
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State | NV
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Zip | 89102-3654
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Country | US
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Telephone | 702-325-9226
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 775
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City | RUTHER GLEN
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State | VA
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Zip | 22546-0775
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Country | US
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Telephone | 702-325-9226
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | NV20121718942
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License Number State | NV
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