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General NPI Number Information
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NPI Number | 1790279974
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Entity Type | Individual
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Provider Name | CHARIS BOLDEN
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Gender | Female
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 2580 N RANCHO DR STE 105
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City | LAS VEGAS
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State | NV
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Zip | 89130-3361
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Country | US
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Telephone | 702-982-3636
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Fax | 702-982-3737
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Provider Business Mailing Address
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Address Line | 8250 N GRAND CANYON DR UNIT 1140
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City | LAS VEGAS
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State | NV
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Zip | 89166-3738
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Country | US
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Telephone | 702-717-4880
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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 |
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License Number State |
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