MEDICARE: YOUR CHOIC BEHAVIORAL

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	5	NV

General Provider Information

NPI Number	:	1265725121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR CHOIC BEHAVIORAL

Provider Business Mailing Address
First Line	:	3785 E SUNSET RD
Second Line	:	SUITE A-10
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-6259
Country	:	US
Telephone Number	:	702-985-2345
Fax Number	:	702-834-8437

Provider Business Practice Location Address
First Line	:	3785 E SUNSET RD
Second Line	:	SUITE # A-10
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-6259
Country	:	US
Telephone Number	:	702-985-2345
Fax Number	:	702-834-8437

Authorized Official
Title or Position	:	OWNER
Name	:	MR. LARRY CLARKE
Credential	:
Telephone Number	:	702-985-2345

Provider Enumeration Date	:	05/25/2011
Last Update Date	:	07/21/2022

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