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NPI Code Detail

MEDICARE: COURTNEY KETTER

MEDICARE: COURTNEY KETTER
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
1103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154615227
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY KETTER
Provider Business Mailing Address
First Line : 6905 DIVER AVE
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89084-3103
Country : US
Telephone Number : 310-409-5882
Fax Number :
Provider Business Practice Location Address
First Line : 3455 W CRAIG RD STE C
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-5119
Country : US
Telephone Number : 702-518-4337
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2011
Last Update Date : 06/06/2011

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Directions to “ COURTNEY KETTER ” Practice Location

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