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NPI Code Detail

MEDICARE: KELLY DEMOS

MEDICARE: KELLY DEMOS
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
1106S00000XBehavior Technician
2106E00000XAssistant Behavior AnalystLABA0321NV

General Provider Information

NPI Number : 1114470531
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY DEMOS
Provider Business Mailing Address
First Line : 8716 CASTLE RIDGE AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-8307
Country : US
Telephone Number : 310-613-3997
Fax Number :
Provider Business Practice Location Address
First Line : 408 S JONES BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89107-2658
Country : US
Telephone Number : 702-502-8021
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2016
Last Update Date : 07/24/2020

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Directions to “ KELLY DEMOS ” Practice Location

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