MEDICARE: DEVELOPMENTAL HORIZONS

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	:	1194275248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVELOPMENTAL HORIZONS

Provider Business Mailing Address
First Line	:	4933 APACHE VALLEY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-5503
Country	:	US
Telephone Number	:	303-378-6764
Fax Number	:

Provider Business Practice Location Address
First Line	:	4933 APACHE VALLEY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-5503
Country	:	US
Telephone Number	:	303-378-6764
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. CARNELL A RAY
Credential	:
Telephone Number	:	303-378-6764

Provider Enumeration Date	:	10/12/2016
Last Update Date	:	10/12/2016

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Directions to “DEVELOPMENTAL HORIZONS ” Practice Location

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