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General NPI Number Information
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NPI Number | 1780421917
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Entity Type | Organization
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Legal Business Name | CREATIVE BEHAVIORAL CONNECTIONS
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Dates
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Enumeration Date | 07/15/2024
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Last Update Date | 07/15/2024
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Provider Practice Location Address
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Address Line | 5803 W CRAIG RD
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City | LAS VEGAS
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State | NV
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Zip | 89130-2536
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Country | US
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Telephone | 702-901-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 10383 ALCOY LN
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City | LAS VEGAS
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State | NV
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Zip | 89135-2422
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | REGISTERED BEHAVIOR TECHNICIAN
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Name | MR. JAMES RAY GAMBLE JR.
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Credential |
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Telephone | 602-434-0682
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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 |
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License Number State |
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