MEDICARE: TIA STAR VALENTINE

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1467047365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIA STAR VALENTINE

Provider Business Mailing Address
First Line	:	4014 CLOVE TREE CT
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89031-0175
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4014 CLOVE TREE CT
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89031-0175
Country	:	US
Telephone Number	:	702-762-6621
Fax Number	:

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

Provider Enumeration Date	:	03/03/2021
Last Update Date	:	03/03/2021

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Directions to “ TIA STAR VALENTINE ” Practice Location

Language	Start Address	Practice Location

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