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General NPI Number Information
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NPI Number | 1740564699
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Entity Type | Organization
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Legal Business Name | TEMPLE OF THE LORD OUTREACH
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 94 ANCIENT HILLS LN
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City | HENDERSON
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State | NV
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Zip | 89074-1750
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Country | US
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Telephone | 702-401-9314
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Fax | 702-475-6845
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Provider Business Mailing Address
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Address Line | 94 ANCIENT HILLS LN
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City | HENDERSON
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State | NV
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Zip | 89074-1750
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Country | US
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Telephone | 702-401-9314
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Fax | 702-465-6845
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. DENNIS GRAY III
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Credential |
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Telephone | 702-401-9314
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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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