MEDICARE: MR. JAMES KING ALLEN JR.

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	:	1215482443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES KING ALLEN JR.

Provider Business Mailing Address
First Line	:	6516 BRIGHT MORNING ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2016
Country	:	US
Telephone Number	:	702-250-2291
Fax Number	:

Provider Business Practice Location Address
First Line	:	6516 BRIGHT MORNING ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-2016
Country	:	US
Telephone Number	:	702-250-2291
Fax Number	:

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

Provider Enumeration Date	:	08/17/2016
Last Update Date	:	08/17/2016

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