MEDICARE: NEAMOUBI MICKLE

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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1144502774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEAMOUBI MICKLE

Provider Business Mailing Address
First Line	:	PO BOX 34809
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89533-4809
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18190 BABY BEAR CT
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89508-5816
Country	:	US
Telephone Number	:	775-677-1356
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2011
Last Update Date	:	09/09/2011

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Directions to “ NEAMOUBI MICKLE ” Practice Location

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