MEDICARE: SIMPLE BEHAVIOR SOLUTIONS 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
1	103K00000X	Behavior Analyst

Other Identifiers

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

General Provider Information

NPI Number	:	1184149874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLE BEHAVIOR SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	12020 SOUTHERN HIGHLANDS PKWY APT 1245
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-3012
Country	:	US
Telephone Number	:	702-762-5305
Fax Number	:

Provider Business Practice Location Address
First Line	:	8565 S EASTERN AVE STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2906
Country	:	US
Telephone Number	:	702-762-5305
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KRYSTAL VAN VOORHIS
Credential	:	MS, BCBA, LBA
Telephone Number	:	702-762-5305

Provider Enumeration Date	:	08/03/2017
Last Update Date	:	08/02/2018

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Directions to “SIMPLE BEHAVIOR SOLUTIONS LLC ” Practice Location

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