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NPI Code Detail

MEDICARE: PROUD MOMENTS ABA OF NEVADA LLC

MEDICARE: PROUD MOMENTS ABA OF NEVADA LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency
2103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11-13-13480OTHERBACB

General Provider Information

NPI Number : 1043780695
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROUD MOMENTS ABA OF NEVADA LLC
Provider Business Mailing Address
First Line : 350 5TH AVE STE 6115
Second Line :
City : NEW YORK
State : NY
Zip : 10118-6002
Country : US
Telephone Number : 718-215-5311
Fax Number :
Provider Business Practice Location Address
First Line : 9089 S PECOS RD STE 3600
Second Line :
City : HENDERSON
State : NV
Zip : 89074-7186
Country : US
Telephone Number : 702-680-1523
Fax Number :
Authorized Official
Title or Position : GENERAL COUNSEL
Name : MARK A YOST
Credential :
Telephone Number : 718-215-5311
Provider Enumeration Date : 11/27/2018
Last Update Date : 03/05/2025

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Directions to “PROUD MOMENTS ABA OF NEVADA LLC ” Practice Location

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